Provider Demographics
NPI:1629572573
Name:HILL, KRISTA BAGGETT (MED,;ED S)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:BAGGETT
Last Name:HILL
Suffix:
Gender:F
Credentials:MED,;ED S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 W LABURNUM AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-4416
Mailing Address - Country:US
Mailing Address - Phone:804-228-5310
Mailing Address - Fax:
Practice Address - Street 1:1600 W LABURNUM AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-4416
Practice Address - Country:US
Practice Address - Phone:804-228-5310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool