Individual
MS. KRISTIN L. RUSSELL MOUTTET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S. , LMFT
Contact information
Practice address
10372 DEMOCRACY LN, FAIRFAX, VA 22030-2522
(703) 591-2551
(703) 591-2563
Mailing address
10372 DEMOCRACY LN, FAIRFAX, VA 22030-2522
(703) 591-2551
(703) 591-2563
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
0717001096
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
239190
ANTHEM - FAIRFAX
VA
01
—
239191
ANTHEM - STERLING
VA
Enumeration date
01/22/2007
Last updated
07/08/2007
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