Provider Demographics
NPI:1992963979
Name:CROTHERS, KRISTINE LEE ANN
Entity type:Individual
Prefix:MS
First Name:KRISTINE
Middle Name:LEE ANN
Last Name:CROTHERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2777 WILLOW AVE APT 167
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-3361
Mailing Address - Country:US
Mailing Address - Phone:559-972-1680
Mailing Address - Fax:
Practice Address - Street 1:2772 MARTIN L KING JR BLVD
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-5345
Practice Address - Country:US
Practice Address - Phone:559-264-6144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)