Provider Demographics
NPI:1205199403
Name:CERTAIN, CHRISTINE (MS EDS NCC LMHC)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:
Last Name:CERTAIN
Suffix:
Gender:F
Credentials:MS EDS NCC LMHC
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:RICHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:1485 S SEMORAN BLVD
Mailing Address - Street 2:SUITE1448
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-5533
Mailing Address - Country:US
Mailing Address - Phone:321-397-3000
Mailing Address - Fax:
Practice Address - Street 1:1485 S SEMORAN BLVD
Practice Address - Street 2:SUITE1448
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-5533
Practice Address - Country:US
Practice Address - Phone:321-397-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11646101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008495100Medicaid