Doctor Name: | BEVERLY KRISTINA GAINES |
NPI Number: | 1053739052 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 3491 Gandy Blvd N Ste 201 Pinellas Park, FL - 337812654 |
Business Phone Number: | 7275470607 |
Business Fax Number: | |
Mailing Address: | 3491 Gandy Blvd N Ste 201, PINELLAS PARK |
State: | FL |
Postal Code: | 337812654 |
Phone Number: | 7275470607 |
Fax Number: | |
NPI Enumeration Date: | 04/07/2014 |
NPI Last Update Date: | 04/07/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |