MEDICARE: KRISTI MICHELLE EMMONS LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	0701005395	VA

General Provider Information

NPI Number	:	1063851178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTI MICHELLE EMMONS LPC

Provider Business Mailing Address
First Line	:	5511 STAPLES MILL RD STE 102
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23228-5445
Country	:	US
Telephone Number	:	804-612-3322
Fax Number	:	804-864-1323

Provider Business Practice Location Address
First Line	:	5511 STAPLES MILL RD STE 102
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23228-5445
Country	:	US
Telephone Number	:	804-612-3322
Fax Number	:	804-864-1323

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2013
Last Update Date	:	06/21/2013

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