Provider Demographics
NPI:1144304973
Name:LEE, KJERSTI H (LPC, LMFT)
Entity type:Individual
Prefix:MRS
First Name:KJERSTI
Middle Name:H
Last Name:LEE
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4638 OLD PRINCESS ANNE RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6453
Mailing Address - Country:US
Mailing Address - Phone:757-467-4646
Mailing Address - Fax:
Practice Address - Street 1:297 INDEPENDENCE BLVD
Practice Address - Street 2:PEMBROKE SIX, SUITE 126
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-2911
Practice Address - Country:US
Practice Address - Phone:757-437-6088
Practice Address - Fax:757-473-5161
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001854101YP2500X
VA0717000733106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA088058OtherOPTIMA
VA004945395Medicaid