Provider Demographics
NPI:1003105008
Name:CLEMENTS, CHRISTINA RAFFA
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:RAFFA
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2290 N RONALD REAGAN BLVD STE 116
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-3534
Mailing Address - Country:US
Mailing Address - Phone:549-281-9959
Mailing Address - Fax:
Practice Address - Street 1:5436 NW MOORHEN TRL
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-4322
Practice Address - Country:US
Practice Address - Phone:772-924-4707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)