Provider Demographics
NPI:1235992876
Name:FORDE, CHRISTIAN E (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:E
Last Name:FORDE
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 MONTEGO BAY RD NW
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-9484
Mailing Address - Country:US
Mailing Address - Phone:762-333-5734
Mailing Address - Fax:
Practice Address - Street 1:139 MONTEGO BAY RD NW
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-9484
Practice Address - Country:US
Practice Address - Phone:762-333-5734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC014182101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health