Provider Demographics
NPI:1003368739
Name:MAXWELL, CHRISTINE ALEXANDRA ESPE (MSED, LCPC, NCC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ALEXANDRA ESPE
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:MSED, LCPC, NCC
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:ALEXANDRA
Other - Last Name:ESPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED, LPC, NCC
Mailing Address - Street 1:PO BOX 1109
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-7109
Mailing Address - Country:US
Mailing Address - Phone:815-756-4875
Mailing Address - Fax:815-756-2944
Practice Address - Street 1:12 HEALTH SERVICES DR
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-9637
Practice Address - Country:US
Practice Address - Phone:815-756-4875
Practice Address - Fax:815-756-2944
Is Sole Proprietor?:No
Enumeration Date:2016-10-28
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178009968101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL474579189001Medicaid