Provider Demographics
NPI:1659157188
Name:PATTERSON, KRISTINE (LPC, RESIDENT)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:LPC, RESIDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 STIGALL DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-3212
Mailing Address - Country:US
Mailing Address - Phone:208-906-5250
Mailing Address - Fax:804-706-1185
Practice Address - Street 1:9844 LORI RD STE 100
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-6691
Practice Address - Country:US
Practice Address - Phone:804-706-1111
Practice Address - Fax:804-706-1185
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704015625101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health