Provider Demographics
NPI:1427066612
Name:RYESON DZAHRISTOS, KRISTIN MARY (MSW LMSW)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:MARY
Last Name:RYESON DZAHRISTOS
Suffix:
Gender:F
Credentials:MSW LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 EAST STREET
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381
Mailing Address - Country:US
Mailing Address - Phone:248-685-9399
Mailing Address - Fax:
Practice Address - Street 1:8623 N WAYNE RD
Practice Address - Street 2:STE 123 HEGIRA PROGRAMS INC
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48381
Practice Address - Country:US
Practice Address - Phone:734-367-0469
Practice Address - Fax:734-367-0791
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801082080104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker