Provider Demographics
NPI:1699548123
Name:WHITBORD, KRISTIN JEAN (SUDRC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:JEAN
Last Name:WHITBORD
Suffix:
Gender:F
Credentials:SUDRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22722 SOLEDAD CANYON RD
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-2629
Mailing Address - Country:US
Mailing Address - Phone:747-474-3119
Mailing Address - Fax:
Practice Address - Street 1:22722 SOLEDAD CANYON RD
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91350-2629
Practice Address - Country:US
Practice Address - Phone:747-474-3119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15896101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)