Provider Demographics
NPI:1508058868
Name:MAGNUSON, KIRSTIN A (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:KIRSTIN
Middle Name:A
Last Name:MAGNUSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ARCHWAY CT
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-2889
Mailing Address - Country:US
Mailing Address - Phone:434-237-2655
Mailing Address - Fax:434-237-4422
Practice Address - Street 1:100 ARCHWAY CT
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-2889
Practice Address - Country:US
Practice Address - Phone:434-237-2655
Practice Address - Fax:434-237-4422
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI757124106H00000X
VA0717001203106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist