Healthcare Provider Details

I. General information

NPI: 1629755426
Provider Name (Legal Business Name): ALYSSA CHRISTIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 W NEW ENGLAND AVE STE 315
WINTER PARK FL
32789-4372
US

IV. Provider business mailing address

444 W NEW ENGLAND AVE STE 315
WINTER PARK FL
32789-4372
US

V. Phone/Fax

Practice location:
  • Phone: 305-908-1115
  • Fax:
Mailing address:
  • Phone: 828-707-6539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH29074
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: