Provider Demographics
NPI:1114164894
Name:ANDERSON, CHRISTINE M (MS, ED, NCC, LCPC)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MS, ED, NCC, LCPC
Other - Prefix:MISS
Other - First Name:CHRISTINE
Other - Middle Name:M
Other - Last Name:RUDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, ED, NCC, LCPC
Mailing Address - Street 1:1024 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ST. CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174
Mailing Address - Country:US
Mailing Address - Phone:630-262-2640
Mailing Address - Fax:630-262-2645
Practice Address - Street 1:1024 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:ST. CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174
Practice Address - Country:US
Practice Address - Phone:630-262-2640
Practice Address - Fax:630-262-2645
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-16
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007692101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional