Provider Demographics
NPI:1093808719
Name:KLINE, MIRIAM B (PC, EDS, LPC, LMFT)
Entity Type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:B
Last Name:KLINE
Suffix:
Gender:F
Credentials:PC, EDS, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 HUNGARY SPRINGS ROAD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23228
Mailing Address - Country:US
Mailing Address - Phone:804-672-6000
Mailing Address - Fax:804-672-9000
Practice Address - Street 1:2901 HUNGARY SPRINGS ROAD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228
Practice Address - Country:US
Practice Address - Phone:804-672-6000
Practice Address - Fax:804-672-9000
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701 002134101Y00000X
VA0717 0001412106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0701 002134OtherLPC LICENSE NUMBER
VA0717 0001412OtherLMFT LICENSE NUMBER