Provider Demographics
NPI:1144678442
Name:MADISON, KRISTI (LPC, LSATP, MAC)
Entity type:Individual
Prefix:DR
First Name:KRISTI
Middle Name:
Last Name:MADISON
Suffix:
Gender:F
Credentials:LPC, LSATP, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9300 FOREST POINT CIR
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4765
Mailing Address - Country:US
Mailing Address - Phone:571-214-7703
Mailing Address - Fax:703-530-9805
Practice Address - Street 1:9300 FOREST POINT CIR
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4765
Practice Address - Country:US
Practice Address - Phone:571-214-7703
Practice Address - Fax:703-530-9805
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-26
Last Update Date:2020-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005709101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional