Healthcare Provider Details

I. General information

NPI: 1992954515
Provider Name (Legal Business Name): CHRISTINA H. PRINCIPE LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2008
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3040 N WICKHAM RD STE 3
MELBOURNE FL
32935-2369
US

IV. Provider business mailing address

3040 N WICKHAM RD STE 3
MELBOURNE FL
32935-2369
US

V. Phone/Fax

Practice location:
  • Phone: 321-987-6198
  • Fax: 321-888-4948
Mailing address:
  • Phone: 321-987-6198
  • Fax: 321-888-4948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number19434
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH12580
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: