Healthcare Provider Details

I. General information

NPI: 1356277180
Provider Name (Legal Business Name): CHRISTINA CRARY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1353 N COURTENAY PKWY STE L
MERRITT ISLAND FL
32953-4463
US

IV. Provider business mailing address

131 INDIGO COVE PL
MELBOURNE BEACH FL
32951-3126
US

V. Phone/Fax

Practice location:
  • Phone: 321-978-5122
  • Fax:
Mailing address:
  • Phone: 303-908-2799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH29036
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: