Provider Demographics
NPI:1407680036
Name:RACE, NINA (RMHCI)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:RACE
Suffix:
Gender:F
Credentials:RMHCI
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4233 WOODLAND RETREAT BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-4599
Mailing Address - Country:US
Mailing Address - Phone:707-849-4316
Mailing Address - Fax:
Practice Address - Street 1:1501 SOUTH PINELLAS AVENUE
Practice Address - Street 2:SUITE Q
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689
Practice Address - Country:US
Practice Address - Phone:727-547-3692
Practice Address - Fax:727-279-3219
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH26393101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health