1639406952 NPI number — MRS. KRISTIN DENISE WOODLING MA, LMHC

Table of content: MRS. KRISTIN DENISE WOODLING MA, LMHC (NPI 1639406952)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639406952 NPI number — MRS. KRISTIN DENISE WOODLING MA, LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOODLING
Provider First Name:
KRISTIN
Provider Middle Name:
DENISE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KISE
Provider Other First Name:
KRISTIN
Provider Other Middle Name:
DENISE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, LMHC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1639406952
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1948 PINEAPPLE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MELBOURNE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32935-7609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-543-2087
Provider Business Mailing Address Fax Number:
321-984-9598

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2225 S BABCOCK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MELBOURNE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32901-5305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-543-2087
Provider Business Practice Location Address Fax Number:
321-984-9598
Provider Enumeration Date:
11/06/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MH9900 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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