Kristen Marie Petrilla, LCDC III, OCPS II

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

081204 Issued in OH

Practice address

1341 Market Ave N
Canton, OH 44714-2605

Phone

(330) 453-8252

Fax

(330) 452-4655

NPI assigned

Aug 16, 2010

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

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

{
    "created_epoch": "1281916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1281916800000",
    "number": "1609181569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 22ND ST NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447093815",
            "telephone_number": "330-452-8252",
            "fax_number": "220-452-4655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1341 MARKET AVE N",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447142605",
            "telephone_number": "330-453-8252",
            "fax_number": "330-452-4655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRILLA",
        "first_name": "KRISTEN",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "LCDC III, OCPS II",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-16",
        "last_updated": "2010-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "081204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Natatia Monique Peterson, CD, PCD, DEM
• Tianna Ty'Sha Peterson
• Michael Petrides, DDS
• Pete Angelo Petrides, DDS, MPH
• Amie Marie Petrik
• Jasmine Petties
• Elizabeth Pfalzgraf
• Emily Pfefferl, LPC
• Taylor Pfister
• Richard Pham, M.D.

• Addiction (Substance Use Disorder) Counselor in Canton, OH
• Providers in Canton, OH by specialty
• Addiction (Substance Use Disorder) Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2010; 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.