Individual
CHRISTEL SHANTEY MCMACKIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3544 EDGEWATER DR, ORLANDO, FL 32804-2922
(407) 291-8009
Mailing address
3544 EDGEWATER DR, ORLANDO, FL 32804-2922
(407) 291-8009
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
IMT3167
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IMT3167
FLORIDA BOARD OF CSW, MFT, AND MHC
FL
Enumeration date
07/16/2018
Last updated
08/16/2019
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