Provider Demographics
NPI:1356647481
Name:PICKETT, CHRISTIE PAULA (LMHC, CAP, CCTP)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:PAULA
Last Name:PICKETT
Suffix:
Gender:F
Credentials:LMHC, CAP, CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8905 REGENTS PARK DR STE 230
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3081
Mailing Address - Country:US
Mailing Address - Phone:813-586-0870
Mailing Address - Fax:813-501-8625
Practice Address - Street 1:8905 REGENTS PARK DR STE 230
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3081
Practice Address - Country:US
Practice Address - Phone:813-586-0870
Practice Address - Fax:813-501-8625
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-08
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11676101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH11676OtherLICENSED MENTAL HEALTH COUNSELOR
FL4873OtherCAP