Provider Demographics
NPI:1063659498
Name:LEWIS, CHRISTINE JOAN (LMHC, NCC, CCMHC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:JOAN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LMHC, NCC, CCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 W VINE ST
Mailing Address - Street 2:SUITE 340
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4643
Mailing Address - Country:US
Mailing Address - Phone:321-746-0486
Mailing Address - Fax:321-746-0486
Practice Address - Street 1:3501 W VINE ST
Practice Address - Street 2:SUITE 340
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4643
Practice Address - Country:US
Practice Address - Phone:321-746-0486
Practice Address - Fax:321-746-0486
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11032101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL805-007-250OtherFARS RATER ID
802-013-500OtherCFARS RATER ID