Provider Demographics
NPI:1235604208
Name:ZIMMERMAN-HALL, CHRISTINE NICOLE
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:NICOLE
Last Name:ZIMMERMAN-HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11951 W PORTAGE RIVER SOUTH RD
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:OH
Mailing Address - Zip Code:43449-8848
Mailing Address - Country:US
Mailing Address - Phone:419-707-3422
Mailing Address - Fax:
Practice Address - Street 1:142 W WATER ST
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:OH
Practice Address - Zip Code:43449-1373
Practice Address - Country:US
Practice Address - Phone:419-707-3033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1700847101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty