Provider Demographics
NPI:1497035836
Name:CANNELLA, CHRISTY L (LMHC)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:L
Last Name:CANNELLA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 SOLUTIONS WAY STE 120
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-3623
Mailing Address - Country:US
Mailing Address - Phone:321-635-9535
Mailing Address - Fax:
Practice Address - Street 1:590 SOLUTIONS WAY STE 120
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3623
Practice Address - Country:US
Practice Address - Phone:321-635-9535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-17
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11726101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health