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General NPI Number Information
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NPI Number | 1508884370
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Entity Type | Individual
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Provider Name | MARK J KRIST LCSW
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Gender | Male
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 10/22/2024
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Provider Practice Location Address
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Address Line | USAMEDDAC 2480 LLEWELLYN AVE
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City | FORT GEORGE G MEADE
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State | MD
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Zip | 20755
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Country | US
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Telephone | 301-677-8136
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Fax |
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Provider Business Mailing Address
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Address Line | 1306 RUTTER ST
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City | BALTIMORE
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State | MD
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Zip | 21217-4136
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Country | US
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Telephone | 646-691-7790
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801085533
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C-09359
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 31210
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License Number State | MD
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