Provider Demographics
NPI:1083489157
Name:WORD, CRISTYL HAWTHORNE (LPC, CSOTP)
Entity Type:Individual
Prefix:MRS
First Name:CRISTYL
Middle Name:HAWTHORNE
Last Name:WORD
Suffix:
Gender:F
Credentials:LPC, CSOTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 TWINWOOD LN
Mailing Address - Street 2:
Mailing Address - City:KENBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:23944-2133
Mailing Address - Country:US
Mailing Address - Phone:681-533-1494
Mailing Address - Fax:
Practice Address - Street 1:131 TWINWOOD LN
Practice Address - Street 2:
Practice Address - City:KENBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:23944-2133
Practice Address - Country:US
Practice Address - Phone:681-533-1494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701013036101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional