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General NPI Number Information
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NPI Number | 1740542786
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Entity Type | Individual
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Provider Name | KRISTINA SUZETTE ERVIN-FUNK REGISTERED CSW
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Gender | Female
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Dates
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Enumeration Date | 06/14/2012
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Last Update Date | 10/10/2025
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Provider Practice Location Address
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Address Line | 9980 MILL ST
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City | LOWER LAKE
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State | CA
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Zip | 95451
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Country | US
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Telephone | 925-384-1583
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2432
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City | CLEARLAKE
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State | CA
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Zip | 95422-2401
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Country | US
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Telephone | 925-384-1583
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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 |
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License Number State |
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