Provider Demographics
NPI:1083881460
Name:MCCLINTIC, KRISANDRA LOUISE (MSW)
Entity Type:Individual
Prefix:
First Name:KRISANDRA
Middle Name:LOUISE
Last Name:MCCLINTIC
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5304 S FLORIDA AVE
Mailing Address - Street 2:SUITE 406
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-4918
Mailing Address - Country:US
Mailing Address - Phone:863-607-4183
Mailing Address - Fax:
Practice Address - Street 1:5304 S FLORIDA AVE
Practice Address - Street 2:SUITE 406
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-4918
Practice Address - Country:US
Practice Address - Phone:863-607-4183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker