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General NPI Number Information
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NPI Number | 1972929735
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Entity Type | Individual
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Provider Name | CHRISTINA GAINES L.M.H.C
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Gender | Female
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Dates
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Enumeration Date | 03/17/2014
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Last Update Date | 06/06/2022
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Provider Practice Location Address
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Address Line | 1009 MAITLAND CENTER COMMONS BLVD STE 212
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City | MAITLAND
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State | FL
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Zip | 32751-7270
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Country | US
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Telephone | 407-636-3532
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Fax |
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Provider Business Mailing Address
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Address Line | 1159 POLK ST NW
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City | PALM BAY
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State | FL
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Zip | 32907-9027
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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 |
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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 | 2473
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License Number State | NH
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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 | IMH11106
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH13616
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License Number State | FL
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