MEDICARE: CHRISTINA LEE WHITE MS, CACII, NCPRSS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	101YP2500X	Professional Counselor
2	101Y00000X	Counselor	FL
3	101YP1600X	Pastoral Counselor	FL
4	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1710466768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA LEE WHITE MS, CACII, NCPRSS

Provider Business Mailing Address
First Line	:	125 COOL SPRINGS BLVD STE 270
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-6574
Country	:	US
Telephone Number	:	888-339-9404
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 S BEACH ST STE 310
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-4409
Country	:	US
Telephone Number	:	386-747-6541
Fax Number	:

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

Provider Enumeration Date	:	08/10/2018
Last Update Date	:	10/14/2022

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