Provider Demographics
NPI:1194395004
Name:ZUPKA, KAITLYN (LPC, NCC)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:ZUPKA
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11908 WATERTON LAKE LN
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:VA
Mailing Address - Zip Code:20136-2229
Mailing Address - Country:US
Mailing Address - Phone:631-875-3226
Mailing Address - Fax:
Practice Address - Street 1:11908 WATERTON LAKE LN
Practice Address - Street 2:
Practice Address - City:BRISTOW
Practice Address - State:VA
Practice Address - Zip Code:20136-2229
Practice Address - Country:US
Practice Address - Phone:631-875-3226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007682101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health