Provider Demographics
NPI:1225424963
Name:DESOUSA, CHRISTINE (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:DESOUSA
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-1684
Mailing Address - Country:US
Mailing Address - Phone:570-397-0045
Mailing Address - Fax:
Practice Address - Street 1:421 S STATE ST
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-1684
Practice Address - Country:US
Practice Address - Phone:570-397-0045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-09
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008085101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor