Provider Demographics
NPI:1043914260
Name:CONTI, CHRISTINA DIANNE (LAPC, NCC, MED)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:DIANNE
Last Name:CONTI
Suffix:
Gender:F
Credentials:LAPC, NCC, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 PAPER TRAIL WAY STE 106
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-5204
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:310 PAPER TRAIL WAY STE 108
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-5204
Practice Address - Country:US
Practice Address - Phone:678-880-4645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC008664101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor