Provider Demographics
NPI:1710198254
Name:LUNDEBERG, KIRSTEN MARIE (LPC, LMFT)
Entity Type:Individual
Prefix:MISS
First Name:KIRSTEN
Middle Name:MARIE
Last Name:LUNDEBERG
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 N ARMISTEAD ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-2937
Mailing Address - Country:US
Mailing Address - Phone:703-333-5328
Mailing Address - Fax:
Practice Address - Street 1:3923 OLD LEE HWY
Practice Address - Street 2:SUITE 63D
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2428
Practice Address - Country:US
Practice Address - Phone:703-599-1478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003520101Y00000X
VA0717001065106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist