Healthcare Provider Details

I. General information

NPI: 1679320410
Provider Name (Legal Business Name): CHRISTINE BONEY HALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTINE BONEY

II. Dates (important events)

Enumeration Date: 04/30/2024
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4421 NW 39TH AVE STE 3
GAINESVILLE FL
32606-7221
US

IV. Provider business mailing address

4421 NW 39TH AVE STE 3
GAINESVILLE FL
32606-7221
US

V. Phone/Fax

Practice location:
  • Phone: 352-380-0209
  • Fax:
Mailing address:
  • Phone: 352-415-4622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH6120
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: