Healthcare Provider Details

I. General information

NPI: 1255466470
Provider Name (Legal Business Name): CHRISTINA LEE FLOYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 11/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 14TH AVE
LONGVIEW WA
98632
US

IV. Provider business mailing address

PO BOX 1847
LONGVIEW WA
98632
US

V. Phone/Fax

Practice location:
  • Phone: 360-423-0203
  • Fax: 360-577-0269
Mailing address:
  • Phone: 360-423-0203
  • Fax: 360-577-0269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCG60816013
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCG60816013
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: