Provider Demographics
NPI:1568963098
Name:NETHERLAND, KRISTINA JANIECE (LMHC, NCC, MAC)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:JANIECE
Last Name:NETHERLAND
Suffix:
Gender:F
Credentials:LMHC, NCC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7601 N FEDERAL HWY STE 100B
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-1608
Mailing Address - Country:US
Mailing Address - Phone:561-336-9323
Mailing Address - Fax:
Practice Address - Street 1:7601 N FEDERAL HWY STE 100B
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-1608
Practice Address - Country:US
Practice Address - Phone:561-336-9323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7273101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health