Provider Demographics
NPI:1154735272
Name:GIMENEZ, CHRISTINA (LMHC)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:GIMENEZ
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 1:1808 HIBISCUS CT N
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-2720
Mailing Address - Country:US
Mailing Address - Phone:727-742-0472
Mailing Address - Fax:
Practice Address - Street 1:2210 TALL PINES DR STE 220
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-5347
Practice Address - Country:US
Practice Address - Phone:727-547-5979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC014317101YP2500X
FLMH14772101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional