Provider Demographics
NPI:1760995211
Name:STEPHENS, KINDRA (MS, LPC)
Entity Type:Individual
Prefix:
First Name:KINDRA
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:KINDRA
Other - Middle Name:
Other - Last Name:WALTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3900 CHESDIN BLVD
Mailing Address - Street 2:
Mailing Address - City:SUTHERLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23885-9577
Mailing Address - Country:US
Mailing Address - Phone:757-633-2661
Mailing Address - Fax:
Practice Address - Street 1:4222 BONNIEBANK RD
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23234-6602
Practice Address - Country:US
Practice Address - Phone:757-633-2661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-07
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007124101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty