Provider Demographics
NPI:1790414837
Name:CHARLOTIN, K'BRIA NEKATY
Entity Type:Individual
Prefix:
First Name:K'BRIA
Middle Name:NEKATY
Last Name:CHARLOTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37312 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33523-3026
Mailing Address - Country:US
Mailing Address - Phone:404-337-7068
Mailing Address - Fax:
Practice Address - Street 1:37312 MAIN AVE
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33523-3026
Practice Address - Country:US
Practice Address - Phone:404-337-7068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical