Provider Demographics
NPI:1740953496
Name:THOMAS, CHRISTINA DERITO (BA, RBT)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:DERITO
Last Name:THOMAS
Suffix:
Gender:F
Credentials:BA, RBT
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:JORDAN
Other - Last Name:DERITO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1500 S DOUGLAS RD STE 230
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-4108
Mailing Address - Country:US
Mailing Address - Phone:844-854-1116
Mailing Address - Fax:305-846-9711
Practice Address - Street 1:1630 BRAEBURN DR
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7371
Practice Address - Country:US
Practice Address - Phone:540-588-9582
Practice Address - Fax:540-380-8155
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician