Provider Demographics
NPI:1154135713
Name:MISFITS PSYCHO THERAPIST
Entity type:Organization
Organization Name:MISFITS PSYCHO THERAPIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIKITA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:CRISSINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-364-8936
Mailing Address - Street 1:7870 TIDEWATER DR. SUITE 206 #255
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:249 CENTRAL PARK AVENUE
Practice Address - Street 2:#300
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462
Practice Address - Country:US
Practice Address - Phone:757-910-8086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty