Provider Demographics
NPI:1992079925
Name:CARRERA, KRISTINA LYNN (MSW, LCSW, LAC)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:LYNN
Last Name:CARRERA
Suffix:
Gender:F
Credentials:MSW, LCSW, LAC
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:LYNN
Other - Last Name:SCULL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:220 RUSKIN DRIVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910
Mailing Address - Country:US
Mailing Address - Phone:719-572-6100
Mailing Address - Fax:719-447-4792
Practice Address - Street 1:2429 S PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-2886
Practice Address - Country:US
Practice Address - Phone:719-564-5070
Practice Address - Fax:719-896-2874
Is Sole Proprietor?:No
Enumeration Date:2012-03-08
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1057101YM0800X
COCSW.099236061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health