Provider Demographics
NPI:1619710928
Name:ADDERLEY, KIERRA (MA)
Entity type:Individual
Prefix:
First Name:KIERRA
Middle Name:
Last Name:ADDERLEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 W NAVY BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32505-8065
Mailing Address - Country:US
Mailing Address - Phone:850-483-1741
Mailing Address - Fax:
Practice Address - Street 1:3250 W NAVY BLVD STE 206
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32505-8065
Practice Address - Country:US
Practice Address - Phone:850-483-1741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-14
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 103TC1900X
FLIMT4122106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling