Provider Demographics
NPI:1366788606
Name:SANDERS, KELLEY CHRISTINE (PHD, CAP)
Entity type:Individual
Prefix:DR
First Name:KELLEY
Middle Name:CHRISTINE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:PHD, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2023 TATUM AVENUE
Mailing Address - Street 2:BUILDGING H, ROOM #110A
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32214
Mailing Address - Country:US
Mailing Address - Phone:904-546-6302
Mailing Address - Fax:
Practice Address - Street 1:2023 TATUM AVENUE
Practice Address - Street 2:BUILDGING H, ROOM #110A
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32214
Practice Address - Country:US
Practice Address - Phone:904-546-6302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-13
Last Update Date:2025-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP2880103TA0400X
FLPY8870103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)