Provider Demographics
NPI:1225670094
Name:NICKERSON, CHRISTINE RAGNAUTH (MA, LPC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:RAGNAUTH
Last Name:NICKERSON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 DARTMOUTH CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-3214
Mailing Address - Country:US
Mailing Address - Phone:214-693-6009
Mailing Address - Fax:
Practice Address - Street 1:1810 8TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-1352
Practice Address - Country:US
Practice Address - Phone:214-702-1548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-14
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79153101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health