Provider Demographics
NPI:1346557337
Name:WILSON, KRISTIAN MONET (LMHC)
Entity Type:Individual
Prefix:MISS
First Name:KRISTIAN
Middle Name:MONET
Last Name:WILSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MISS
Other - First Name:KRISTIAN
Other - Middle Name:MONET
Other - Last Name:SAMUELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9034 BIGHORN TRL
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32222-1672
Mailing Address - Country:US
Mailing Address - Phone:904-597-6303
Mailing Address - Fax:904-404-8351
Practice Address - Street 1:9034 BIGHORN TRL
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32222-1672
Practice Address - Country:US
Practice Address - Phone:904-597-6303
Practice Address - Fax:904-404-8351
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-12
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11336101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health