MEDICARE: KRISTIN MARIE VITKO 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	7167	NC
2	101YM0800X	Mental Health Counselor	0701005638	VA

General Provider Information

NPI Number	:	1780836510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN MARIE VITKO LPC

Provider Business Mailing Address
First Line	:	2805 SABLE RD
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23233-1654
Country	:	US
Telephone Number	:	919-428-7209
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 BYRD AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23230-3033
Country	:	US
Telephone Number	:	919-428-7209
Fax Number	:

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

Provider Enumeration Date	:	10/10/2008
Last Update Date	:	05/03/2022

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