Provider Demographics
NPI:1225183635
Name:ENTICKNAP, CHRISTINA W (LPC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:W
Last Name:ENTICKNAP
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:M
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, NCC
Mailing Address - Street 1:2512 SE 25TH AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-2075
Mailing Address - Country:US
Mailing Address - Phone:503-544-3201
Mailing Address - Fax:
Practice Address - Street 1:2512 SE 25TH AVE STE 202
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-2075
Practice Address - Country:US
Practice Address - Phone:503-544-3201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1966101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500676083Medicaid
ORC1966OtherOREGON BOARD OF LICENSED PROFESSIONAL COUNSELORS AN
OR19964OtherBOARD OF LICENSED PROFESSIONAL COUNSELORS AND THERAPISTS