Provider Demographics
NPI:1174189872
Name:CHOICE, KISHA (LCSW, CAP)
Entity Type:Individual
Prefix:
First Name:KISHA
Middle Name:
Last Name:CHOICE
Suffix:
Gender:F
Credentials:LCSW, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13377 N 56TH ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERR
Mailing Address - State:FL
Mailing Address - Zip Code:33617-1161
Mailing Address - Country:US
Mailing Address - Phone:181-270-5225
Mailing Address - Fax:813-200-3278
Practice Address - Street 1:13377 N 56TH ST
Practice Address - Street 2:
Practice Address - City:TEMPLE TERR
Practice Address - State:FL
Practice Address - Zip Code:33617-1161
Practice Address - Country:US
Practice Address - Phone:813-270-5225
Practice Address - Fax:813-200-3278
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-17
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW139101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical