Healthcare Provider Details

I. General information

NPI: 1063203206
Provider Name (Legal Business Name): CHRISTINE YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 S PARK AVE
SANFORD FL
32771-4419
US

IV. Provider business mailing address

349 GOLFSIDE CV
LONGWOOD FL
32779-7101
US

V. Phone/Fax

Practice location:
  • Phone: 407-821-8582
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH29034
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: