Healthcare Provider Details

I. General information

NPI: 1215367362
Provider Name (Legal Business Name): KRISTEN HEDRICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2013
Last Update Date: 11/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 BUSH RIVER DR
FARMVILLE VA
23901-3179
US

IV. Provider business mailing address

341 CA IRA RD
CUMBERLAND VA
23040-2820
US

V. Phone/Fax

Practice location:
  • Phone: 434-392-3187
  • Fax:
Mailing address:
  • Phone: 434-414-2773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701005615
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: