Provider Demographics
NPI:1053458661
Name:PURCELL, CHRISTINA JOHNSON (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:JOHNSON
Last Name:PURCELL
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:6040 PUBLIC LANDING ROAD
Mailing Address - Street 2:
Mailing Address - City:SNOW HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21863-2453
Mailing Address - Country:US
Mailing Address - Phone:410-632-1100
Mailing Address - Fax:410-632-5682
Practice Address - Street 1:6040 PUBLIC LANDING RD.
Practice Address - Street 2:
Practice Address - City:SNOW HILL
Practice Address - State:MD
Practice Address - Zip Code:21863-2453
Practice Address - Country:US
Practice Address - Phone:410-632-1100
Practice Address - Fax:410-632-5682
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDG117931041C0700X
MD16323104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD705371101Medicaid
MDS013Medicare ID - Type Unspecified