Provider Demographics
NPI:1902504384
Name:MORRISON, KRISTINA M (CDCA)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:M
Last Name:MORRISON
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:M
Other - Last Name:BAUGHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CDCA
Mailing Address - Street 1:625 CLEVELAND AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44702-1805
Mailing Address - Country:US
Mailing Address - Phone:330-455-0374
Mailing Address - Fax:330-453-6716
Practice Address - Street 1:2600 SIXTH ST SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710-1702
Practice Address - Country:US
Practice Address - Phone:330-830-3393
Practice Address - Fax:234-521-7091
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.187304101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0010271Medicaid