Provider Demographics
NPI:1659906402
Name:MADU, KRISTINE V (LCSW)
Entity type:Individual
Prefix:MS
First Name:KRISTINE
Middle Name:V
Last Name:MADU
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 WILLOW LAWN DRIVE STE 304
Mailing Address - Street 2:THE SHOPS AT WILLOW LAWN #1049
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3423
Mailing Address - Country:US
Mailing Address - Phone:804-803-3306
Mailing Address - Fax:
Practice Address - Street 1:1601 WILLOW LAWN DRIVE STE 304
Practice Address - Street 2:THE SHOPS AT WILLOW LAWN #1049
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3423
Practice Address - Country:US
Practice Address - Phone:804-803-3306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-11
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040115331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical