Provider Demographics
NPI:1598266371
Name:PASQUA, KRISTIN CHAMPINE (LPC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:CHAMPINE
Last Name:PASQUA
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 E BAYOU RD
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-8036
Mailing Address - Country:US
Mailing Address - Phone:985-446-5244
Mailing Address - Fax:
Practice Address - Street 1:312 E BAYOU RD
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-8036
Practice Address - Country:US
Practice Address - Phone:985-446-5244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPLC9434101Y00000X
171M00000X
LA9434101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator