MEDICARE: MS. KRISTIN CAROLINE FORD REGISTERED RECOVERY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1346390994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTIN CAROLINE FORD REGISTERED RECOVERY

Provider Business Mailing Address
First Line	:	622 CENTRAL AVE
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93454-5713
Country	:	US
Telephone Number	:	805-925-5717
Fax Number	:

Provider Business Practice Location Address
First Line	:	6500 MORRO RD
Second Line	:
City	:	ATASCADERO
State	:	CA
Zip	:	93422-4142
Country	:	US
Telephone Number	:	805-461-5212
Fax Number	:	805-461-5873

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	07/08/2007

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