Provider Demographics
NPI:1710466768
Name:WHITE, CHRISTINA LEE (MS, CACII, NCPRSS)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:LEE
Last Name:WHITE
Suffix:
Gender:F
Credentials:MS, CACII, NCPRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 COOL SPRINGS BLVD STE 270
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-6574
Mailing Address - Country:US
Mailing Address - Phone:888-339-9404
Mailing Address - Fax:
Practice Address - Street 1:140 S BEACH ST STE 310
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-4409
Practice Address - Country:US
Practice Address - Phone:386-747-6541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-10
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 175T00000X
FL101Y00000X, 101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No175T00000XOther Service ProvidersPeer Specialist