Provider Demographics
NPI:1134493687
Name:KESSLER, CHRISTINE MARIE (BCBA, LMSW, MSW)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:MARIE
Last Name:KESSLER
Suffix:
Gender:F
Credentials:BCBA, LMSW, MSW
Other - Prefix:MISS
Other - First Name:CHRISTINE
Other - Middle Name:MARIE
Other - Last Name:CANDELARIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW, MSW
Mailing Address - Street 1:21501 LAKEBREEZE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48082-2206
Mailing Address - Country:US
Mailing Address - Phone:989-621-7662
Mailing Address - Fax:
Practice Address - Street 1:21501 LAKEBREEZE ST
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48082-2206
Practice Address - Country:US
Practice Address - Phone:989-621-7662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-01
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-15-18490103K00000X
MI68010939961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical