Provider Demographics
NPI:1306266507
Name:CLAXTON, GINA MARIE (MSW)
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:MARIE
Last Name:CLAXTON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4404 SOUTH FLORIDA AVENUE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-4053
Mailing Address - Country:US
Mailing Address - Phone:863-709-8110
Mailing Address - Fax:863-709-8118
Practice Address - Street 1:4404 SOUTH FLORIDA AVENUE
Practice Address - Street 2:SUITE 301
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-4053
Practice Address - Country:US
Practice Address - Phone:863-709-8110
Practice Address - Fax:863-709-8118
Is Sole Proprietor?:No
Enumeration Date:2014-04-27
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X, 106H00000X
FLSW137911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist