Provider Demographics
NPI:1205256815
Name:ST. CROIX, CRISTINE (LCSW)
Entity type:Individual
Prefix:
First Name:CRISTINE
Middle Name:
Last Name:ST. CROIX
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10151 DEERWOOD PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-0566
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2701 NW 23RD BLVD
Practice Address - Street 2:APT. A 12
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-5906
Practice Address - Country:US
Practice Address - Phone:352-812-9216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW118451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical