Provider Demographics
NPI:1639899396
Name:OSBORNE, KIRSTEN CARRELL
Entity Type:Individual
Prefix:MRS
First Name:KIRSTEN
Middle Name:CARRELL
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 FIRST COLONIAL RD STE B
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3078
Mailing Address - Country:US
Mailing Address - Phone:757-395-1405
Mailing Address - Fax:757-222-5095
Practice Address - Street 1:1020 FIRST COLONIAL RD STE B
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3078
Practice Address - Country:US
Practice Address - Phone:757-395-1405
Practice Address - Fax:757-222-5095
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701011139101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health