Provider Demographics
NPI:1316678121
Name:JUSTICE, KRISTY NICOLE (LCSW)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:NICOLE
Last Name:JUSTICE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 ROYAL ST
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641-2822
Mailing Address - Country:US
Mailing Address - Phone:276-701-4586
Mailing Address - Fax:
Practice Address - Street 1:120 ROYAL ST
Practice Address - Street 2:
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641-2822
Practice Address - Country:US
Practice Address - Phone:276-701-4586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040141041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical