Provider Demographics
NPI:1164248480
Name:PATRICK, CHRISTOPHER ANDREW (LMHC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ANDREW
Last Name:PATRICK
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5965 NW WOLVERINE RD
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-3649
Mailing Address - Country:US
Mailing Address - Phone:732-803-2673
Mailing Address - Fax:
Practice Address - Street 1:5965 NW WOLVERINE RD
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-3649
Practice Address - Country:US
Practice Address - Phone:732-803-2673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH24354101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor