Healthcare Provider Details

I. General information

NPI: 1447719158
Provider Name (Legal Business Name): KRISTEN ELIZABETH WATSON LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTEN ELIZABETH HARDGROVE LCMHC

II. Dates (important events)

Enumeration Date: 03/13/2019
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 CENTER SCHOOL RD
WEST CHARLESTON VT
05872-9501
US

IV. Provider business mailing address

2735 DANE HILL RD
WEST CHARLESTON VT
05872-9581
US

V. Phone/Fax

Practice location:
  • Phone: 802-673-6476
  • Fax:
Mailing address:
  • Phone: 802-673-6476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068.0127269
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: