Healthcare Provider Details

I. General information

NPI: 1982530267
Provider Name (Legal Business Name): KRISTINA KORANEK LRC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17336 PICKWICK DR STE 101
PURCELLVILLE VA
20132-6180
US

IV. Provider business mailing address

17336 PICKWICK DR STE 101
PURCELLVILLE VA
20132-6180
US

V. Phone/Fax

Practice location:
  • Phone: 804-207-6737
  • Fax:
Mailing address:
  • Phone: 804-207-6737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0704019343
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: