Provider Demographics
NPI:1730327511
Name:WASSER, KRISTA J (MAED,LPCC,LICDC-CS)
Entity type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:J
Last Name:WASSER
Suffix:
Gender:F
Credentials:MAED,LPCC,LICDC-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5925 STILLSON PL
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-2929
Mailing Address - Country:US
Mailing Address - Phone:330-774-0536
Mailing Address - Fax:
Practice Address - Street 1:1011 BOARDMAN CANFIELD RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-4226
Practice Address - Country:US
Practice Address - Phone:330-629-2434
Practice Address - Fax:330-629-2199
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-01
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0800048101YP2500X, 101Y00000X, 101YM0800X, 101YA0400X
OHICDC.161123-CS101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)