Provider Demographics
NPI:1558184424
Name:TRAYNOR, KAITLIN MARIE I
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:MARIE
Last Name:TRAYNOR
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3402 BROCKWOOD CT APT A
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23294-8730
Mailing Address - Country:US
Mailing Address - Phone:804-892-3047
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 2922
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23058-2922
Practice Address - Country:US
Practice Address - Phone:804-613-4348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704015385101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health