Provider Demographics
NPI:1053723411
Name:COFFING-BLAIN, CRISTA ELIZABETH (LMHC)
Entity type:Individual
Prefix:
First Name:CRISTA
Middle Name:ELIZABETH
Last Name:COFFING-BLAIN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 S ORANGE AVE SUITE 104 #1446
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801
Mailing Address - Country:US
Mailing Address - Phone:904-720-7629
Mailing Address - Fax:
Practice Address - Street 1:255 S ORANGE AVE SUITE 104 #1446
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801
Practice Address - Country:US
Practice Address - Phone:904-720-7629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLATR00-141101Y00000X
FLIMH11428101YM0800X
NM00-141221700000X
FL00-141221700000X
FL16915101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist