Provider Demographics
NPI:1629615539
Name:DAMRON, KRISTI KAY (LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:KAY
Last Name:DAMRON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 E LAFAYETTE ST STE 103
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-4546
Mailing Address - Country:US
Mailing Address - Phone:850-290-2211
Mailing Address - Fax:
Practice Address - Street 1:1020 E LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-4569
Practice Address - Country:US
Practice Address - Phone:850-290-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL157911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical