Provider Demographics
NPI:1780381277
Name:CHRISTOPHER, KAIYAH ELAINE
Entity type:Individual
Prefix:
First Name:KAIYAH
Middle Name:ELAINE
Last Name:CHRISTOPHER
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 1:1843 W 33RD ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-3284
Mailing Address - Country:US
Mailing Address - Phone:904-607-1436
Mailing Address - Fax:
Practice Address - Street 1:1843 W 33RD ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-3284
Practice Address - Country:US
Practice Address - Phone:904-607-1436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRBT-23-254759106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician