Healthcare Provider Details

I. General information

NPI: 1497029011
Provider Name (Legal Business Name): KRISTINE B RAND LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/29/2012
Last Update Date: 10/22/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 E PLUME ST # 327B
NORFOLK VA
23510-1757
US

IV. Provider business mailing address

208 E PLUME ST # 327B
NORFOLK VA
23510-1757
US

V. Phone/Fax

Practice location:
  • Phone: 757-637-0840
  • Fax:
Mailing address:
  • Phone: 757-637-0840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number00664356
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904007871
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: