Individual
KAITLIN ELIZABETH BOUNTRESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
15521 MIDLOTHIAN TPKE STE 105, MIDLOTHIAN, VA 23113-7313
(804) 423-1550
Mailing address
15521 MIDLOTHIAN TPKE STE 105, MIDLOTHIAN, VA 23113-7313
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810005772
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
—
Enumeration date
07/18/2018
Last updated
07/18/2018
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