Provider Demographics
NPI:1780836510
Name:VITKO, KRISTIN MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MARIE
Last Name:VITKO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:BIRD
Other - Middle Name:
Other - Last Name:VITKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2805 SABLE RD
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1654
Mailing Address - Country:US
Mailing Address - Phone:919-428-7209
Mailing Address - Fax:
Practice Address - Street 1:1900 BYRD AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3033
Practice Address - Country:US
Practice Address - Phone:919-428-7209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-10
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7167101YP2500X
VA0701005638101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional