Provider Demographics
NPI:1205038593
Name:JOHNSON, CHRISTINA JAMES (LPC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:JAMES
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 E STATE ROUTE 72
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-3940
Mailing Address - Country:US
Mailing Address - Phone:573-364-2900
Mailing Address - Fax:573-364-2902
Practice Address - Street 1:1303 E STATE ROUTE 72
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-3940
Practice Address - Country:US
Practice Address - Phone:573-364-2900
Practice Address - Fax:573-364-2902
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2008-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003030263101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO498734805Medicaid