Provider Demographics
NPI:1376138602
Name:FORD, KAMISHA (BSW, MNPA)
Entity Type:Individual
Prefix:
First Name:KAMISHA
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:BSW, MNPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13375 ARBOR POINTE CIR APT 101
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-1141
Mailing Address - Country:US
Mailing Address - Phone:304-982-9644
Mailing Address - Fax:
Practice Address - Street 1:13375 ARBOR POINTE CIR APT 101
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-1141
Practice Address - Country:US
Practice Address - Phone:304-982-9644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-08
Last Update Date:2021-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No171W00000XOther Service ProvidersContractor
No251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency