Provider Demographics
NPI:1154076321
Name:WALTER, CHRISTINE (MFT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:WALTER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 NE 19TH AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3070
Mailing Address - Country:US
Mailing Address - Phone:954-319-7010
Mailing Address - Fax:
Practice Address - Street 1:5379 LYONS RD # 3173
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-2810
Practice Address - Country:US
Practice Address - Phone:954-319-7010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT3646106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIMT3646OtherFLORIDA BOARD OF CLINICAL SOCIAL WORK, MARRIAGE & FAMILY THERAPY AND MENTAL HEAL