Provider Demographics
NPI:1639406952
Name:WOODLING, KRISTIN DENISE (MA, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:DENISE
Last Name:WOODLING
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:MISS
Other - First Name:KRISTIN
Other - Middle Name:DENISE
Other - Last Name:KISE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMHC
Mailing Address - Street 1:1948 PINEAPPLE AVE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-7609
Mailing Address - Country:US
Mailing Address - Phone:321-543-2087
Mailing Address - Fax:321-984-9598
Practice Address - Street 1:2225 S BABCOCK ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-5305
Practice Address - Country:US
Practice Address - Phone:321-543-2087
Practice Address - Fax:321-984-9598
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health