Provider Demographics
NPI:1942188289
Name:NELSON, KRISTI (CDCA)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:539 FIGUEROA PL SE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44707-1452
Mailing Address - Country:US
Mailing Address - Phone:330-481-7156
Mailing Address - Fax:
Practice Address - Street 1:4069 BRADLEY CIR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2565
Practice Address - Country:US
Practice Address - Phone:866-835-1364
Practice Address - Fax:330-409-9081
Is Sole Proprietor?:No
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.193446101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)