Provider Demographics
NPI:1174251110
Name:FLORENCE, KATHY MAE (MFTA)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:MAE
Last Name:FLORENCE
Suffix:
Gender:F
Credentials:MFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3309 BOB WALLACE AVE SW STE 1
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35805-4007
Mailing Address - Country:US
Mailing Address - Phone:256-686-9195
Mailing Address - Fax:
Practice Address - Street 1:500 COLONIAL LAKE DR APT 511
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-2272
Practice Address - Country:US
Practice Address - Phone:334-538-6840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALA134101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional