Provider Demographics
NPI:1932288990
Name:CRENSHAW, KRISTINA (LMHC)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:CRENSHAW
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 1:185 SUMMERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-2636
Mailing Address - Country:US
Mailing Address - Phone:904-273-8119
Mailing Address - Fax:904-273-2944
Practice Address - Street 1:5000 SAWGRASS VILLAGE CIR
Practice Address - Street 2:SUITE 9
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-5045
Practice Address - Country:US
Practice Address - Phone:904-280-8555
Practice Address - Fax:904-280-8562
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH1853101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health