Provider Demographics
NPI:1598276859
Name:GARRETT, KRYSTEN DANIELLE HEATH (LPC, CSAC)
Entity Type:Individual
Prefix:
First Name:KRYSTEN
Middle Name:DANIELLE HEATH
Last Name:GARRETT
Suffix:
Gender:F
Credentials:LPC, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3235 ELECTRIC RD STE 1A
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-6404
Mailing Address - Country:US
Mailing Address - Phone:540-788-5090
Mailing Address - Fax:
Practice Address - Street 1:3235 ELECTRIC RD STE 1A
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-6404
Practice Address - Country:US
Practice Address - Phone:540-788-5090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-13
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710103018101YA0400X
VA0701007312101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1437137734Medicaid