Provider Demographics
NPI:1063812972
Name:TRUMBO, KRISTEE JO ROSENOW (LPC)
Entity type:Individual
Prefix:
First Name:KRISTEE
Middle Name:JO ROSENOW
Last Name:TRUMBO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 594
Mailing Address - Street 2:
Mailing Address - City:BROADWAY
Mailing Address - State:VA
Mailing Address - Zip Code:22815-0594
Mailing Address - Country:US
Mailing Address - Phone:540-246-1461
Mailing Address - Fax:
Practice Address - Street 1:362 DORSET ST
Practice Address - Street 2:
Practice Address - City:BROADWAY
Practice Address - State:VA
Practice Address - Zip Code:22815-9485
Practice Address - Country:US
Practice Address - Phone:540-246-1461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005929101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional