Provider Demographics
NPI:1851953350
Name:HALL, KELLY CHRISTINA (LMSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:CHRISTINA
Last Name:HALL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2618 E CHELSEA ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-7743
Mailing Address - Country:US
Mailing Address - Phone:706-495-5263
Mailing Address - Fax:
Practice Address - Street 1:109 N OAKWOOD AVE STE 105
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-4629
Practice Address - Country:US
Practice Address - Phone:813-819-8704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1975121041C0700X
MO20170387811041C0700X
FLSW221501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical