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General NPI Number Information
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NPI Number | 1366788606
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Entity Type | Individual
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Provider Name | KELLEY CHRISTINE SANDERS PH.D., CAP
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Gender | Female
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Dates
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Enumeration Date | 12/13/2012
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Last Update Date | 02/02/2025
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Provider Practice Location Address
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Address Line | 2023 TATUM AVENUE BUILDGING H, ROOM #110A
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City | JACKSONVILLE
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State | FL
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Zip | 32214
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Country | US
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Telephone | 904-546-6302
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Fax |
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Provider Business Mailing Address
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Address Line | 2023 TATUM AVENUE BUILDGING H, ROOM #110A
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City | JACKSONVILLE
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State | FL
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Zip | 32214
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Country | US
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Telephone | 904-546-6302
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number | CAP2880
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY8870
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License Number State | FL
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