Provider Demographics
NPI:1003541657
Name:STRONG, KRISTIE JO
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:JO
Last Name:STRONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 FRONT ROYAL PIKE
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22602-7313
Mailing Address - Country:US
Mailing Address - Phone:540-546-3436
Mailing Address - Fax:540-665-5280
Practice Address - Street 1:290 FRONT ROYAL PIKE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22602-7313
Practice Address - Country:US
Practice Address - Phone:540-546-3436
Practice Address - Fax:540-665-5280
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0732001485171M00000X
VA0710103682101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator