Provider Demographics
NPI:1033815410
Name:WILLIAMS, CHRISTINA IZABELE
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:IZABELE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:IZABEL
Other - Middle Name:CHRISTIINA
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 BEACH CLUB DR UNIT 705
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32550-8504
Mailing Address - Country:US
Mailing Address - Phone:850-502-0908
Mailing Address - Fax:
Practice Address - Street 1:907 MAR WALT DR STE 2022
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6631
Practice Address - Country:US
Practice Address - Phone:850-243-0095
Practice Address - Fax:850-374-3192
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH20720390200000X
FLMH22069101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program