Provider Demographics
NPI:1528109246
Name:ERVANIAN, KRISTIE A (CAGS, LMHC)
Entity type:Individual
Prefix:
First Name:KRISTIE
Middle Name:A
Last Name:ERVANIAN
Suffix:
Gender:F
Credentials:CAGS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1087 WARWICK AVE REAR UNIT
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888
Mailing Address - Country:US
Mailing Address - Phone:401-383-2200
Mailing Address - Fax:401-256-5209
Practice Address - Street 1:1087 WARWICK AVE REAR UNIT
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888
Practice Address - Country:US
Practice Address - Phone:401-383-2200
Practice Address - Fax:401-256-5209
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor