Provider Demographics
NPI:1295888501
Name:HARDEE, KRISTIN LYNN (LPC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LYNN
Last Name:HARDEE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W 19TH ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23517-2218
Mailing Address - Country:US
Mailing Address - Phone:757-622-7017
Mailing Address - Fax:757-640-8402
Practice Address - Street 1:222 W 19TH ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-2218
Practice Address - Country:US
Practice Address - Phone:757-622-7017
Practice Address - Fax:757-640-8402
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004009101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional