Provider Demographics
NPI:1194442475
Name:MCCALL, KRISTIN LASHAE TAYLOR (LPC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LASHAE TAYLOR
Last Name:MCCALL
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 1:3436 DANA LN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-4057
Mailing Address - Country:US
Mailing Address - Phone:804-439-3644
Mailing Address - Fax:
Practice Address - Street 1:1919 COMMERCE DR STE 240
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-4269
Practice Address - Country:US
Practice Address - Phone:757-755-3253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701011816101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health