Provider Demographics
NPI:1528551702
Name:BRINKLEY, CHRISTIAN BLAKE (MA)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:BLAKE
Last Name:BRINKLEY
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12770 E HIGHWAY 25
Mailing Address - Street 2:
Mailing Address - City:OCKLAWAHA
Mailing Address - State:FL
Mailing Address - Zip Code:32179-5105
Mailing Address - Country:US
Mailing Address - Phone:352-470-4488
Mailing Address - Fax:
Practice Address - Street 1:12770 E HIGHWAY 25
Practice Address - Street 2:
Practice Address - City:OCKLAWAHA
Practice Address - State:FL
Practice Address - Zip Code:32179-5105
Practice Address - Country:US
Practice Address - Phone:352-470-4488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor