Provider Demographics
NPI:1447719158
Name:WATSON, KRISTEN ELIZABETH (LCMHC)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ELIZABETH
Last Name:WATSON
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:ELIZABETH
Other - Last Name:HARDGROVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCMHC
Mailing Address - Street 1:2735 DANE HILL RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHARLESTON
Mailing Address - State:VT
Mailing Address - Zip Code:05872-9581
Mailing Address - Country:US
Mailing Address - Phone:802-673-6476
Mailing Address - Fax:
Practice Address - Street 1:4095 GORE RD
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:VT
Practice Address - Zip Code:05829-9408
Practice Address - Country:US
Practice Address - Phone:802-895-4166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0127269101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health