Provider Demographics
NPI:1497337448
Name:MIDDLETON, CHRISTY
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22302 HIGHWAY 231
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:FL
Mailing Address - Zip Code:32438-1804
Mailing Address - Country:US
Mailing Address - Phone:850-832-7848
Mailing Address - Fax:
Practice Address - Street 1:22302 HIGHWAY 231
Practice Address - Street 2:
Practice Address - City:FOUNTAIN
Practice Address - State:FL
Practice Address - Zip Code:32438-1804
Practice Address - Country:US
Practice Address - Phone:850-832-7848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health