Provider Demographics
NPI:1003309576
Name:RAILSBACK, CHRISTINE DAWN (LPC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:DAWN
Last Name:RAILSBACK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:DAWN
Other - Last Name:POLAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:700 BROOKSEDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-3394
Mailing Address - Country:US
Mailing Address - Phone:614-882-9338
Mailing Address - Fax:
Practice Address - Street 1:700 BROOKSEDGE BLVD
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-3394
Practice Address - Country:US
Practice Address - Phone:614-882-9338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC1500070101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health