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General NPI Number Information
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NPI Number | 1073928792
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Entity Type | Organization
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Legal Business Name | CHRISTINE RUSHFORD
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Dates
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Enumeration Date | 06/23/2014
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Last Update Date | 06/23/2014
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Provider Practice Location Address
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Address Line | 2196 SARDINIA CT
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City | NAVARRE
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State | FL
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Zip | 32566-4186
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Country | US
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Telephone | 850-420-2640
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Fax |
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Provider Business Mailing Address
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Address Line | 2196 SARDINIA CT
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City | NAVARRE
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State | FL
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Zip | 32566-4186
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTINE RUSHFORD
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Credential |
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Telephone | 850-420-2640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | IMH10694
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License Number State | FL
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