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General NPI Number Information
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NPI Number | 1053723411
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Entity Type | Individual
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Provider Name | CRISTA ELIZABETH COFFING-BLAIN LMHC
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Gender | Female
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Dates
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Enumeration Date | 05/20/2014
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Last Update Date | 09/20/2024
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Provider Practice Location Address
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Address Line | 255 S ORANGE AVE SUITE 104 #1446
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City | ORLANDO
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State | FL
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Zip | 32801
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Country | US
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Telephone | 904-720-7629
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Fax |
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Provider Business Mailing Address
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Address Line | 255 S ORANGE AVE SUITE 104 #1446
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City | ORLANDO
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State | FL
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Zip | 32801
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Country | US
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Telephone | 904-720-7629
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | ATR00-141
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | IMH11428
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 221700000X
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Taxonomy Name | Art Therapist
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License Number | 00-141
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License Number State | NM
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Taxonomy #4
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Taxonomy Code | 221700000X
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Taxonomy Name | Art Therapist
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License Number | 00-141
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 16915
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License Number State | FL
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