Provider Demographics
NPI:1336364280
Name:FADIL, CHRISTINE ANN (PSYD, LMHC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ANN
Last Name:FADIL
Suffix:
Gender:F
Credentials:PSYD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 NW 108TH TER
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-4021
Mailing Address - Country:US
Mailing Address - Phone:305-905-2265
Mailing Address - Fax:954-432-0345
Practice Address - Street 1:700 S ROYAL POINCIANA BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-6600
Practice Address - Country:US
Practice Address - Phone:305-371-8300
Practice Address - Fax:305-371-1376
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4708101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health