Healthcare Provider Details

I. General information

NPI: 1275041931
Provider Name (Legal Business Name): CHRISTINA CHONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2018
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8480 SW 107TH ST
MIAMI FL
33156-3530
US

IV. Provider business mailing address

8480 SW 107TH ST
MIAMI FL
33156-3530
US

V. Phone/Fax

Practice location:
  • Phone: 786-553-0596
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMT5468
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: