Provider Demographics
NPI:1558172452
Name:HOLMAN, KRISTINA ANN (LPC)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:ANN
Last Name:HOLMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2241
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-2241
Mailing Address - Country:US
Mailing Address - Phone:907-355-5773
Mailing Address - Fax:
Practice Address - Street 1:4830 E MOSSWOOD DR
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-4409
Practice Address - Country:US
Practice Address - Phone:907-355-5773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK232939101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty