Provider Demographics
NPI:1225701410
Name:TALBOTT, KIRSTEN NICOLE (LPC)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:NICOLE
Last Name:TALBOTT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4860 COX RD STE 200
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-9248
Mailing Address - Country:US
Mailing Address - Phone:804-396-4106
Mailing Address - Fax:804-358-0034
Practice Address - Street 1:4860 COX RD STE 200
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-9248
Practice Address - Country:US
Practice Address - Phone:804-396-4106
Practice Address - Fax:804-358-0034
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-26
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010665101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA30017443320001Medicaid