Healthcare Provider Details

I. General information

NPI: 1477120863
Provider Name (Legal Business Name): CRISTON DINGER LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2021
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 WHITEHALL DR STE 107
ST AUGUSTINE FL
32086-5268
US

IV. Provider business mailing address

278 TRILLO ST
ST AUGUSTINE FL
32086-7321
US

V. Phone/Fax

Practice location:
  • Phone: 904-377-3982
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberMH19237
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: