Provider Demographics
NPI:1174202816
Name:STOCK, KRISTIN (LRIC)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:
Last Name:STOCK
Suffix:
Gender:F
Credentials:LRIC
Other - Prefix:MS
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:BOWDLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4460 CORPORATION LN STE 300
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-3150
Mailing Address - Country:US
Mailing Address - Phone:757-376-8167
Mailing Address - Fax:757-452-4447
Practice Address - Street 1:4460 CORPORATION LN STE 300
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-3150
Practice Address - Country:US
Practice Address - Phone:757-376-8167
Practice Address - Fax:757-452-4447
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704015835101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health