Provider Demographics
NPI:1164288544
Name:STOLL, CHRISTINE A (CPRS)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:A
Last Name:STOLL
Suffix:
Gender:F
Credentials:CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 CLYDE AVE APT H
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-5178
Mailing Address - Country:US
Mailing Address - Phone:330-775-8250
Mailing Address - Fax:
Practice Address - Street 1:1034 BROWN ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44301-1515
Practice Address - Country:US
Practice Address - Phone:330-388-3922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.004285101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty