Provider Demographics
NPI:1013651850
Name:INGEBRETSEN, KAITLIN FLORENCE (MA, LPC, BC-DMT)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:FLORENCE
Last Name:INGEBRETSEN
Suffix:
Gender:F
Credentials:MA, LPC, BC-DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8003 FRANKLIN FARMS DR RM 101
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-5107
Mailing Address - Country:US
Mailing Address - Phone:804-716-0428
Mailing Address - Fax:
Practice Address - Street 1:8003 FRANKLIN FARMS DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-5107
Practice Address - Country:US
Practice Address - Phone:804-716-0428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-27
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225600000X
VA0701011406101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist