Provider Demographics
NPI:1689988610
Name:ROOT, KRIS MARIE (LCMHC)
Entity Type:Individual
Prefix:
First Name:KRIS
Middle Name:MARIE
Last Name:ROOT
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5403 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:VT
Mailing Address - Zip Code:05445-9487
Mailing Address - Country:US
Mailing Address - Phone:802-425-7224
Mailing Address - Fax:
Practice Address - Street 1:5403 LAKE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:VT
Practice Address - Zip Code:05445-9487
Practice Address - Country:US
Practice Address - Phone:802-425-7224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0680000650101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health