MEDICARE: CHRISTINA MINER RESIDENT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	0704018911	VA

General Provider Information

NPI Number	:	1548111222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA MINER RESIDENT

Provider Business Mailing Address
First Line	:	1050 TEMPLE AVE PMB# 221
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9850 LORI RD
Second Line	:
City	:	CHESTERFIELD
State	:	VA
Zip	:	23832-6758
Country	:	US
Telephone Number	:	804-353-3585
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2026
Last Update Date	:	02/07/2026

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Directions to “ CHRISTINA MINER RESIDENT” Practice Location

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