Provider Demographics
NPI:1427783505
Name:VARDAKIS-SPILLANE, KRISTIN (MA-ATR)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:VARDAKIS-SPILLANE
Suffix:
Gender:F
Credentials:MA-ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14919 KAMPUTA DR
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-1514
Mailing Address - Country:US
Mailing Address - Phone:703-463-0443
Mailing Address - Fax:
Practice Address - Street 1:150 S WASHINGTON ST STE 203
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-2921
Practice Address - Country:US
Practice Address - Phone:703-606-6213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
06-166221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist