Provider Demographics
NPI:1326610882
Name:ELLIS STRICKLER, KRISTEN (MED, QMHP)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:
Last Name:ELLIS STRICKLER
Suffix:
Gender:F
Credentials:MED, QMHP
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:BLAIRE
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:M ED, QMHP
Mailing Address - Street 1:10049 MIDLOTHIAN TUMPIKE
Mailing Address - Street 2:B2
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235
Mailing Address - Country:US
Mailing Address - Phone:804-320-8032
Mailing Address - Fax:
Practice Address - Street 1:10049 MIDLOTHIAN TUMPIKE
Practice Address - Street 2:B2
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235
Practice Address - Country:US
Practice Address - Phone:804-320-8032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0709024028101YA0400X
VA0732007746101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)