Provider Demographics
NPI:1346767720
Name:PURKISS, CHRISTINA (LMHC, CEDS)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:PURKISS
Suffix:
Gender:F
Credentials:LMHC, CEDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-5404
Mailing Address - Country:US
Mailing Address - Phone:407-622-0202
Mailing Address - Fax:
Practice Address - Street 1:1345 CLAY ST
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-5404
Practice Address - Country:US
Practice Address - Phone:407-622-0202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-25
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13696101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health