Provider Demographics
NPI:1629384912
Name:FLOYD, KRISTINA BONIC (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:BONIC
Last Name:FLOYD
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:MS
Other - First Name:KRISTINA
Other - Middle Name:LAUREN
Other - Last Name:BONIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:3804 EDNOR RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-2051
Mailing Address - Country:US
Mailing Address - Phone:917-515-5834
Mailing Address - Fax:
Practice Address - Street 1:10440 SHAKER DR STE 105
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-2342
Practice Address - Country:US
Practice Address - Phone:443-343-2885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD162611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical