Provider Demographics
NPI:1770173577
Name:THOMPSON-BUSH, KRISTEL M (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KRISTEL
Middle Name:M
Last Name:THOMPSON-BUSH
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 1:1900 BYRD AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3033
Mailing Address - Country:US
Mailing Address - Phone:804-592-6311
Mailing Address - Fax:
Practice Address - Street 1:1900 BYRD AVE STE 103
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3033
Practice Address - Country:US
Practice Address - Phone:804-592-6311
Practice Address - Fax:844-227-7690
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040125971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical