Provider Demographics
NPI:1164605572
Name:RISTAINO, PIA MARIA (LMHC)
Entity Type:Individual
Prefix:
First Name:PIA
Middle Name:MARIA
Last Name:RISTAINO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:PIA
Other - Middle Name:M
Other - Last Name:RISTAINO-ABELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 748519
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-8519
Mailing Address - Country:US
Mailing Address - Phone:904-376-3800
Mailing Address - Fax:904-376-3998
Practice Address - Street 1:14540 OLD SAINT AUGUSTINE RD STE 2591
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-7420
Practice Address - Country:US
Practice Address - Phone:904-376-3800
Practice Address - Fax:904-376-3998
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-07
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA376101YA0400X
FLLMHC181169101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD406755000Medicaid