Provider Demographics
NPI:1235196312
Name:ROSE, CHRISTIE (LCSW-C-)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:LCSW-C-
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:8322 SHARON DRIVE
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-8011
Mailing Address - Country:US
Mailing Address - Phone:301-874-5593
Mailing Address - Fax:301-874-5593
Practice Address - Street 1:176 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE105
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4410
Practice Address - Country:US
Practice Address - Phone:240-447-3991
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD127191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDK786-0001OtherCAREFIRST-GHMSI
MD361279OtherMHN
MD646762-01OtherCAREFIRST OF MARYLAND
MD9409731OtherPHCS
MD361279OtherMHN
MD646762-01OtherCAREFIRST OF MARYLAND