Provider Demographics
NPI:1053802181
Name:MALLEY, KRISTINA ERIKA (MA, NCC, LPC)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:ERIKA
Last Name:MALLEY
Suffix:
Gender:F
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 GAY ST STE 6
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-3852
Mailing Address - Country:US
Mailing Address - Phone:610-489-3333
Mailing Address - Fax:
Practice Address - Street 1:601 GAY ST STE 6
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-3852
Practice Address - Country:US
Practice Address - Phone:610-489-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-24
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC010436101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional