Provider Demographics
NPI:1619293420
Name:DEGENHARDT, CHRISTINA RENAE (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:RENAE
Last Name:DEGENHARDT
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2759 STATE ROAD 580 STE 113
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-3352
Mailing Address - Country:US
Mailing Address - Phone:727-409-2277
Mailing Address - Fax:
Practice Address - Street 1:2759 STATE ROAD 580 STE 113
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-3352
Practice Address - Country:US
Practice Address - Phone:727-409-2277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-19
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 9557101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health