Provider Demographics
NPI:1891544920
Name:KLINE, MARY VIRGINIA (RMHCI)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:VIRGINIA
Last Name:KLINE
Suffix:
Gender:F
Credentials:RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 GLENVIEW DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-5207
Mailing Address - Country:US
Mailing Address - Phone:813-842-6187
Mailing Address - Fax:
Practice Address - Street 1:1840 FIDDLER CT
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4450
Practice Address - Country:US
Practice Address - Phone:813-842-6187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH22016101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health