Healthcare Provider Details

I. General information

NPI: 1053586842
Provider Name (Legal Business Name): CHRISTINE MARIE LIVINGSTON PHD LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTINE WALLACE

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 09/03/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 SAWMILL FOREST CT
ST AUGUSTINE FL
32086
US

IV. Provider business mailing address

CHRISTINE LIVINGSTON 196 SAWMILL FOREST COURT
ST AUGUSTINE FL
32086
US

V. Phone/Fax

Practice location:
  • Phone: 603-986-7589
  • Fax:
Mailing address:
  • Phone: 603-986-7589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number906
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: