Provider Demographics
NPI:1225889470
Name:KINTZIOS, KASSANDRA RAE (LCSW)
Entity Type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:RAE
Last Name:KINTZIOS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 GROVE AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-4481
Mailing Address - Country:US
Mailing Address - Phone:703-300-2808
Mailing Address - Fax:
Practice Address - Street 1:8310 MIDLOTHIAN TPKE
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-5163
Practice Address - Country:US
Practice Address - Phone:804-447-6382
Practice Address - Fax:804-447-6383
Is Sole Proprietor?:No
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical