Provider Demographics
NPI:1235538661
Name:SANTA MARIA, CHRISTINA JACLYN (LMSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:JACLYN
Last Name:SANTA MARIA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 E BIG BEAVER RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1905
Mailing Address - Country:US
Mailing Address - Phone:248-524-0881
Mailing Address - Fax:248-524-8850
Practice Address - Street 1:1225 E BIG BEAVER RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1905
Practice Address - Country:US
Practice Address - Phone:248-524-0881
Practice Address - Fax:248-524-8850
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010969641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical