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NPI Code Detail

MEDICARE: KERRY ANN KRUK-BORISOV LPC, ATR-BC, CSAC

MEDICARE: KERRY ANN KRUK-BORISOV LPC, ATR-BC, CSAC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor0710102187VA
2221700000XArt Therapist0701005892VA
3101YP2500XProfessional Counselor0701005892VA

General Provider Information

NPI Number : 1316390420
Entity Type Code : Individual
Provider Name (Legal Business Name) : KERRY ANN KRUK-BORISOV LPC, ATR-BC, CSAC
Provider Business Mailing Address
First Line : 3140 HERBERT ST
Second Line :
City : NORFOLK
State : VA
Zip : 23513-2302
Country : US
Telephone Number : 757-589-3498
Fax Number :
Provider Business Practice Location Address
First Line : 2200 COLONIAL AVE STE 12
Second Line :
City : NORFOLK
State : VA
Zip : 23517-1919
Country : US
Telephone Number : 757-937-5780
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2016
Last Update Date : 10/19/2023

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