Provider Demographics
NPI:1255228607
Name:KING, KRISTEN MARIE (CSAC-A)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MARIE
Last Name:KING
Suffix:
Gender:F
Credentials:CSAC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 DORIA HILL DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-9456
Mailing Address - Country:US
Mailing Address - Phone:703-986-9876
Mailing Address - Fax:
Practice Address - Street 1:5322 LADYSMITH RD
Practice Address - Street 2:
Practice Address - City:RUTHER GLEN
Practice Address - State:VA
Practice Address - Zip Code:22546-1325
Practice Address - Country:US
Practice Address - Phone:888-887-6867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0711000764101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)