Provider Demographics
NPI:1922886159
Name:CARTWRIGHT, KISSIAH (MS)
Entity Type:Individual
Prefix:
First Name:KISSIAH
Middle Name:
Last Name:CARTWRIGHT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12210 GREENWICH DR
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-7023
Mailing Address - Country:US
Mailing Address - Phone:678-687-8799
Mailing Address - Fax:
Practice Address - Street 1:4530 WISCONSIN AVE NW
Practice Address - Street 2:
Practice Address - City:DC
Practice Address - State:VA
Practice Address - Zip Code:23059
Practice Address - Country:US
Practice Address - Phone:202-699-1108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional