Provider Demographics
NPI:1649721846
Name:BALL, KRISTINA (LMHC)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:BALL
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 1:7048 COLUMNS CIR
Mailing Address - Street 2:APT 208
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-3646
Mailing Address - Country:US
Mailing Address - Phone:813-486-7999
Mailing Address - Fax:
Practice Address - Street 1:7048 COLUMNS CIR
Practice Address - Street 2:APT 208
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-3646
Practice Address - Country:US
Practice Address - Phone:813-486-7999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-23
Last Update Date:2016-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14217101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health