Provider Demographics
NPI:1558042481
Name:SPROUSE, KRISTIE LEE (LPC-R)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:LEE
Last Name:SPROUSE
Suffix:
Gender:F
Credentials:LPC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 LILAC LN
Mailing Address - Street 2:
Mailing Address - City:HUDGINS
Mailing Address - State:VA
Mailing Address - Zip Code:23076-2138
Mailing Address - Country:US
Mailing Address - Phone:804-882-5534
Mailing Address - Fax:
Practice Address - Street 1:10978 BUCKLEY HALL ROAD SUITE 1
Practice Address - Street 2:
Practice Address - City:MATHEWS
Practice Address - State:VA
Practice Address - Zip Code:23109
Practice Address - Country:US
Practice Address - Phone:804-725-3041
Practice Address - Fax:804-725-3510
Is Sole Proprietor?:No
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704015081101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health