Healthcare Provider Details

I. General information

NPI: 1487329686
Provider Name (Legal Business Name): KRISTEN THOMPSON EDWARDS PH.D, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. KRISTEN THOMPSON

II. Dates (important events)

Enumeration Date: 08/11/2021
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 6TH AVE E
BIG STONE GAP VA
24219-2408
US

IV. Provider business mailing address

622 6TH AVE E
BIG STONE GAP VA
24219-2408
US

V. Phone/Fax

Practice location:
  • Phone: 423-833-8120
  • Fax:
Mailing address:
  • Phone: 423-833-8120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4824
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701013661
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: