Kristina Ann Dement

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

R1486461022 Issued in CA

Practice address

5494 Pony Express TRL
Camino, CA 95709-9403

Phone

(530) 644-3758

Fax

(530) 644-3782

NPI assigned

Nov 2, 2022

Last updated

Nov 2, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Progress House, Inc.

  • Substance Abuse Rehabilitation Facility
  • Camino, CA
  • NPI 1104961101
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1667347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667347200000",
    "number": "1346957974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2844 COLOMA ST",
            "city": "PLACERVILLE",
            "state": "CA",
            "postal_code": "956674406",
            "telephone_number": "530-644-3758",
            "fax_number": "530-644-3782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5494 PONY EXPRESS TRL",
            "city": "CAMINO",
            "state": "CA",
            "postal_code": "957099403",
            "telephone_number": "530-644-3758",
            "fax_number": "530-644-3782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEMENT",
        "first_name": "KRISTINA",
        "middle_name": "ANN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-11-02",
        "last_updated": "2022-11-02",
        "certification_date": "2022-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "R1486461022",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeanne Marie Conca, MPT
• Jay B Dalto, D.P.T.
• Sara Marie Daniels, RADT-1
• Dana Dean
• Kimberly Sue Dehn, OTR/L
• Kali Duke
• El Dorado County Fire Protection District
• Raven Elkins
• Chantele Fleming, RADT 1
• Katherine Anastasia Franks, SUDRC

• Addiction (Substance Use Disorder) Counselor in Camino, CA
• Providers in Camino, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.