Provider Demographics
NPI:1477742021
Name:MCGRAW CONDRON, KRISTEN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:
Last Name:MCGRAW CONDRON
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 1:300 MEDICAL DR
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-1765
Mailing Address - Country:US
Mailing Address - Phone:757-788-0300
Mailing Address - Fax:757-788-0969
Practice Address - Street 1:200 MEDICAL DR
Practice Address - Street 2:SUITE A
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-1763
Practice Address - Country:US
Practice Address - Phone:757-788-0200
Practice Address - Fax:757-788-0950
Is Sole Proprietor?:No
Enumeration Date:2007-10-19
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040053621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACO3714OtherMEDICARE
VA4945573Medicaid
VA4945573Medicaid