Provider Demographics
NPI:1578761300
Name:PALAZZO, CHRISTINA LEWANDO (MS,LPC)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:LEWANDO
Last Name:PALAZZO
Suffix:
Gender:F
Credentials:MS,LPC
Other - Prefix:MISS
Other - First Name:CHRISTINA
Other - Middle Name:MARIE
Other - Last Name:LEWANDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:664 MAUNA LOA DR
Mailing Address - Street 2:
Mailing Address - City:DIAMONDHEAD
Mailing Address - State:MS
Mailing Address - Zip Code:39525-3471
Mailing Address - Country:US
Mailing Address - Phone:228-547-5578
Mailing Address - Fax:228-220-5707
Practice Address - Street 1:1000 KILN DELISLE RD STE D
Practice Address - Street 2:
Practice Address - City:PASS CHRISTIAN
Practice Address - State:MS
Practice Address - Zip Code:39571-9701
Practice Address - Country:US
Practice Address - Phone:601-283-2281
Practice Address - Fax:228-220-5707
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS759101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00018213Medicaid