Provider Demographics
NPI:1407907173
Name:KIRTSEY, WAYNETTIA MARIA (MA, LMHC)
Entity type:Individual
Prefix:MISS
First Name:WAYNETTIA
Middle Name:MARIA
Last Name:KIRTSEY
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2987 CAPTIVA BLUFF RD N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32226-2063
Mailing Address - Country:US
Mailing Address - Phone:904-536-6869
Mailing Address - Fax:
Practice Address - Street 1:2987 CAPTIVA BLUFF RD N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32226-2063
Practice Address - Country:US
Practice Address - Phone:904-536-6869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7634382 00Medicaid