Healthcare Provider Details

I. General information

NPI: 1295246072
Provider Name (Legal Business Name): CHRISTINA EAGLE LMHC, LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2017
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 JERICHO TPKE STE 212
FLORAL PARK NY
11001-2019
US

IV. Provider business mailing address

22 HAWLEY LN
MONROE CT
06468-1249
US

V. Phone/Fax

Practice location:
  • Phone: 732-936-7340
  • Fax:
Mailing address:
  • Phone: 929-232-4540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number009472
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC012795
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: