Provider Demographics
NPI:1487028601
Name:EVERETT, CRISTA L (MED, MA, RMHCI)
Entity Type:Individual
Prefix:
First Name:CRISTA
Middle Name:L
Last Name:EVERETT
Suffix:
Gender:F
Credentials:MED, MA, RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 SW 186TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-3168
Mailing Address - Country:US
Mailing Address - Phone:352-443-9389
Mailing Address - Fax:
Practice Address - Street 1:1414 SW 186TH ST
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:FL
Practice Address - Zip Code:32669-3168
Practice Address - Country:US
Practice Address - Phone:352-443-9389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-27
Last Update Date:2015-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health