Provider Demographics
NPI:1588677462
Name:FOWLER, KRISTEN MICHELLE (LPC, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:MICHELLE
Last Name:FOWLER
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:103 MARY BIERBAUER WAY
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-2037
Mailing Address - Country:US
Mailing Address - Phone:757-753-8401
Mailing Address - Fax:757-223-9783
Practice Address - Street 1:780 PILOT HOUSE DR
Practice Address - Street 2:SUITE 100A
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4411
Practice Address - Country:US
Practice Address - Phone:757-223-7821
Practice Address - Fax:757-223-7820
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003529101YP2500X
VA0717001126106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist