Provider Demographics
NPI:1770949679
Name:BERRY, CHRISTINA SLEDGE (MS, LMHC)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:SLEDGE
Last Name:BERRY
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6268 OLD BETHEL RD
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-5505
Mailing Address - Country:US
Mailing Address - Phone:850-353-2677
Mailing Address - Fax:
Practice Address - Street 1:6268 OLD BETHEL RD
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-5505
Practice Address - Country:US
Practice Address - Phone:850-353-2677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-07
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH16397101Y00000X, 101YM0800X
FLIMH14347171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171W00000XOther Service ProvidersContractor