Provider Demographics
NPI:1508695917
Name:ROLDAN, KRYSTELLE M (LPC)
Entity type:Individual
Prefix:
First Name:KRYSTELLE
Middle Name:M
Last Name:ROLDAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1292 CORSAIR DR APT 102
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-5423
Mailing Address - Country:US
Mailing Address - Phone:860-514-6267
Mailing Address - Fax:
Practice Address - Street 1:409 BIRDNECK CIR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-5516
Practice Address - Country:US
Practice Address - Phone:757-385-6950
Practice Address - Fax:757-437-4710
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-01
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701014368101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional