Provider Demographics
NPI:1043619794
Name:POOLE, CHRISTIE (MFT)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:
Last Name:POOLE
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4595 TOWNE LAKE PKWY
Mailing Address - Street 2:BUILDING 300 SUITE 250
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-5514
Mailing Address - Country:US
Mailing Address - Phone:678-631-7639
Mailing Address - Fax:
Practice Address - Street 1:4595 TOWNE LAKE PKWY
Practice Address - Street 2:BUILDING 300 SUITE 250
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-5514
Practice Address - Country:US
Practice Address - Phone:678-631-7639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001275101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional