Provider Demographics
NPI:1780891275
Name:KRAMP, CAROLYN S (MA, LMFT)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:S
Last Name:KRAMP
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9335 LEE HWY
Mailing Address - Street 2:APT. 405
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-1818
Mailing Address - Country:US
Mailing Address - Phone:703-851-4763
Mailing Address - Fax:
Practice Address - Street 1:9300 FOREST POINT CIR
Practice Address - Street 2:SUITE 152
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4700
Practice Address - Country:US
Practice Address - Phone:703-331-0311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717000455106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9048853OtherPHCS PROVDR ID
VA236114OtherANTHEM BXBC ID
VA236115OtherANTHEM BXBC ID