Healthcare Provider Details

I. General information

NPI: 1114420643
Provider Name (Legal Business Name): KRISTINA HUCKSTEP LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2018
Last Update Date: 11/14/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 E 5TH AVE # 1028
ANCHORAGE AK
99501-2519
US

IV. Provider business mailing address

A MINDFUL JOURNEY LLC 243 E 5TH AVE #1028
ANCHORAGE AK
99501
US

V. Phone/Fax

Practice location:
  • Phone: 907-726-4657
  • Fax:
Mailing address:
  • Phone: 907-726-4657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW14649
License Number StateFL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: