Provider Demographics
NPI:1679320410
Name:HALL, CHRISTINE BONEY
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:BONEY
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:BONEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4421 NW 39TH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-7221
Mailing Address - Country:US
Mailing Address - Phone:352-415-4622
Mailing Address - Fax:
Practice Address - Street 1:4421 NW 39TH AVE STE 3
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-7221
Practice Address - Country:US
Practice Address - Phone:352-380-0209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6120101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health