Provider Demographics
NPI:1619512852
Name:CHRISTIAN, TREVENE TRISHAN
Entity Type:Individual
Prefix:
First Name:TREVENE
Middle Name:TRISHAN
Last Name:CHRISTIAN
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 1:1717 MASON AVE APT 1126
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5133
Mailing Address - Country:US
Mailing Address - Phone:386-383-2854
Mailing Address - Fax:
Practice Address - Street 1:2400 S RIDGEWOOD AVE STE 32
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-3073
Practice Address - Country:US
Practice Address - Phone:386-316-9823
Practice Address - Fax:386-304-7619
Is Sole Proprietor?:No
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional