Provider Demographics
NPI:1053191262
Name:HENINGER-DAY, KRISTY LEE (CADC-I)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:LEE
Last Name:HENINGER-DAY
Suffix:
Gender:F
Credentials:CADC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 N 12TH AVE SUITE #109
Mailing Address - Street 2:BX 324
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230
Mailing Address - Country:US
Mailing Address - Phone:559-309-3405
Mailing Address - Fax:
Practice Address - Street 1:1489 W LACEY BLVD STE 105
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-5957
Practice Address - Country:US
Practice Address - Phone:559-978-7803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACI139730823101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)