Provider Demographics
NPI:1770914921
Name:MARTIN, CHRISTINA (LPC)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6767 N WICKHAM RD STE 306
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-2025
Mailing Address - Country:US
Mailing Address - Phone:321-751-1925
Mailing Address - Fax:321-751-9261
Practice Address - Street 1:6767 N WICKHAM RD STE 306
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-2025
Practice Address - Country:US
Practice Address - Phone:321-751-1925
Practice Address - Fax:321-751-9261
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-12
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007593101Y00000X
FLMH13369101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor