Provider Demographics
NPI:1144937129
Name:LATHEM, KRISTYNA LEA (MS, LPC)
Entity type:Individual
Prefix:MRS
First Name:KRISTYNA
Middle Name:LEA
Last Name:LATHEM
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 SCENIC VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-1319
Mailing Address - Country:US
Mailing Address - Phone:540-838-5000
Mailing Address - Fax:
Practice Address - Street 1:135 SCENIC VIEW CIR
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-1319
Practice Address - Country:US
Practice Address - Phone:540-838-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704014392101YM0800X
FLTPMC4124101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional