Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003105008 |
---|---|
Provider Name | Christina Raffa Clements |
First Address | Fort Pierce, FL 34979-3563 |
Second Address | Port St Lucie, FL 34986-4322 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2011 |
Last Update Date | 08/10/2014 |