Provider Demographics
NPI:1386964161
Name:JANA, KRISTA (PHD)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:JANA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 HARRIS ST STE 201C
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-4584
Mailing Address - Country:US
Mailing Address - Phone:434-227-6631
Mailing Address - Fax:
Practice Address - Street 1:700 HARRIS ST STE 201
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-4584
Practice Address - Country:US
Practice Address - Phone:434-227-6631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003769103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0810003769OtherLICENSE TO PRACTICE PSYCHOLOGY