Provider Demographics
NPI:1043409725
Name:VAN HORN, CHRISTINE E
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:E
Last Name:VAN HORN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 E 2ND ST APT 4
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-7200
Mailing Address - Country:US
Mailing Address - Phone:443-896-3058
Mailing Address - Fax:
Practice Address - Street 1:120 W CHURCH ST STE 2D
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-7812
Practice Address - Country:US
Practice Address - Phone:443-896-3058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2355101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional