Provider Demographics
NPI:1861549974
Name:KRESSER, MARY (PHD, LPC, LCSW, CAC)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:KRESSER
Suffix:
Gender:F
Credentials:PHD, LPC, LCSW, CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 24TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:VA
Mailing Address - Zip Code:23801-1716
Mailing Address - Country:US
Mailing Address - Phone:804-734-9942
Mailing Address - Fax:877-974-1008
Practice Address - Street 1:700 24TH ST
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:VA
Practice Address - Zip Code:23801-1716
Practice Address - Country:US
Practice Address - Phone:804-734-9942
Practice Address - Fax:877-974-1008
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904006403101YA0400X
VA0701003295101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)