Provider Demographics
NPI:1497324172
Name:MARKHAM, KELLY CARTER (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:CARTER
Last Name:MARKHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:CARTER
Other - Last Name:POPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3247 SUNDIAL CIR
Mailing Address - Street 2:
Mailing Address - City:CANTONMENT
Mailing Address - State:FL
Mailing Address - Zip Code:32533-2608
Mailing Address - Country:US
Mailing Address - Phone:850-449-3694
Mailing Address - Fax:
Practice Address - Street 1:400 VETERANS AVE
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-2410
Practice Address - Country:US
Practice Address - Phone:228-523-4783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL93581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical