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General NPI Number Information
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NPI Number | 1003105008
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Entity Type | Individual
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Provider Name | CHRISTINA RAFFA CLEMENTS
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Gender | Female
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Dates
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Enumeration Date | 03/31/2011
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Last Update Date | 04/18/2023
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Provider Practice Location Address
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Address Line | 5436 NW MOORHEN TRL
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City | PORT ST LUCIE
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State | FL
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Zip | 34986-4322
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Country | US
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Telephone | 772-924-4707
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Fax |
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Provider Business Mailing Address
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Address Line | 2290 N RONALD REAGAN BLVD STE 116
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City | LONGWOOD
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State | FL
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Zip | 32750-3534
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Country | US
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Telephone | 549-281-9959
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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