Provider Demographics
NPI:1376821637
Name:WILLIAMS KELLY, CHRISTINE NATASHA (MA)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:NATASHA
Last Name:WILLIAMS KELLY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 FAULKNER ST SW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32908-4825
Mailing Address - Country:US
Mailing Address - Phone:321-271-8213
Mailing Address - Fax:
Practice Address - Street 1:1900 S HARBOR CITY BLVD STE 103
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-4725
Practice Address - Country:US
Practice Address - Phone:321-271-8213
Practice Address - Fax:321-726-0404
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH16677101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health