Provider Demographics
NPI:1568823235
Name:CRAVEN, KINASYA (LMHC)
Entity Type:Individual
Prefix:
First Name:KINASYA
Middle Name:
Last Name:CRAVEN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 W MIDWAY RD
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34981-4823
Mailing Address - Country:US
Mailing Address - Phone:772-468-5600
Mailing Address - Fax:
Practice Address - Street 1:1759 W BROADWAY ST
Practice Address - Street 2:SUITE 3
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-8128
Practice Address - Country:US
Practice Address - Phone:407-977-4335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-09
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH19960101YM0800X
FLIMH 14349101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health