Provider Demographics
NPI:1710377122
Name:KRISHA, BETH ANN (MS, EDS)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:KRISHA
Suffix:
Gender:F
Credentials:MS, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 PIN OAK DR
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:24064-1261
Mailing Address - Country:US
Mailing Address - Phone:540-293-8006
Mailing Address - Fax:
Practice Address - Street 1:4542 BLUE RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:VA
Practice Address - Zip Code:24064-1820
Practice Address - Country:US
Practice Address - Phone:540-977-2181
Practice Address - Fax:540-977-2183
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-23
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0803000248103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool