Provider Demographics
NPI:1285369934
Name:MICHAELIDES, KRYSTA (NCC, LGPC-DC-VA)
Entity type:Individual
Prefix:
First Name:KRYSTA
Middle Name:
Last Name:MICHAELIDES
Suffix:
Gender:F
Credentials:NCC, LGPC-DC-VA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 WILSON BLVD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-2458
Mailing Address - Country:US
Mailing Address - Phone:703-705-2457
Mailing Address - Fax:
Practice Address - Street 1:1627 K ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-1702
Practice Address - Country:US
Practice Address - Phone:202-517-5112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLGPC200001363101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health