Provider Demographics
NPI:1851040315
Name:FREDERICO, KRISTEN MAE (LPCC)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:MAE
Last Name:FREDERICO
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8940 KINGSRIDGE DR STE 106
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45458-1632
Mailing Address - Country:US
Mailing Address - Phone:937-813-4485
Mailing Address - Fax:
Practice Address - Street 1:1825 COMMERCE CENTER BLVD
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-6336
Practice Address - Country:US
Practice Address - Phone:937-879-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.2505678101YP2500X
OHC.2305185101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor