Provider Demographics
NPI:1033874466
Name:DELOACH, CHRISTINA SUSAN (MED, LPC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:SUSAN
Last Name:DELOACH
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 SIOUX TRL
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78639-9636
Mailing Address - Country:US
Mailing Address - Phone:254-630-6169
Mailing Address - Fax:
Practice Address - Street 1:1615 SIOUX TRL
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:TX
Practice Address - Zip Code:78639-9636
Practice Address - Country:US
Practice Address - Phone:254-630-6169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82495101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82495OtherTEXAS STATE BOARD OF EXAMINERS OF PROFESSIONAL COUNSELORS LPC