Provider Demographics
NPI:1689995169
Name:WILCOXON, KAFFIE GALLMON (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:KAFFIE
Middle Name:GALLMON
Last Name:WILCOXON
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 1:4 SEA LN S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-3941
Mailing Address - Country:US
Mailing Address - Phone:727-823-3905
Mailing Address - Fax:
Practice Address - Street 1:4 SEA LN S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-3941
Practice Address - Country:US
Practice Address - Phone:727-823-3905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-18
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6872101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health