Provider Demographics
NPI:1952548513
Name:CHRISTOPHER, CHRISTINE M (IMH 9687)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:CHRISTOPHER
Suffix:
Gender:F
Credentials:IMH 9687
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6910 NW DOROTHY ST
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-1413
Mailing Address - Country:US
Mailing Address - Phone:772-284-0200
Mailing Address - Fax:
Practice Address - Street 1:6910 NW DOROTHY ST
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-1413
Practice Address - Country:US
Practice Address - Phone:772-284-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-19
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health