Provider Demographics
NPI:1336687680
Name:LERCH, CHRISTINA JEAN (MA, NCC, LMHC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:JEAN
Last Name:LERCH
Suffix:
Gender:F
Credentials:MA, NCC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2719 N CHAMBERLAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34286-9308
Mailing Address - Country:US
Mailing Address - Phone:941-276-5229
Mailing Address - Fax:941-629-0237
Practice Address - Street 1:18245 PAULSON DR UNIT 116
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33954-1019
Practice Address - Country:US
Practice Address - Phone:941-276-5229
Practice Address - Fax:941-629-0237
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-07
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14732101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor