Provider Demographics
NPI:1558894154
Name:DANIEL, KRISTIE M (PHD)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:M
Last Name:DANIEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:794 FOXRIDGE CENTER DR STE 109
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-5775
Mailing Address - Country:US
Mailing Address - Phone:904-375-2549
Mailing Address - Fax:
Practice Address - Street 1:794 FOXRIDGE CENTER DR STE 109
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-5775
Practice Address - Country:US
Practice Address - Phone:904-375-2549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral