Organization
CHILD & ADOLESCENT TREATMENT CENTER
Active
Other names
Krissa E Kirby
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT C COOLIDGE (AGENT/REPRESENTATIVE)
(386) 774-5211
Entity
Organization
Contact information
Practice address
1950 LEE RD, SUITE 202, WINTER PARK, FL 32789-1859
(407) 739-5874
(407) 644-1292
Mailing address
PO BOX 741240, ORANGE CITY, FL 32774-1240
(386) 774-5211
(386) 774-5251
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
PY6399
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
54725
FL BLUE SHIELD
FL
Enumeration date
08/23/2007
Last updated
04/20/2008
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