Provider Demographics
NPI:1265660955
Name:LEOTTA-SELBY, CHRISTINE (LPC, LCADC)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:
Last Name:LEOTTA-SELBY
Suffix:
Gender:F
Credentials:LPC, LCADC
Other - Prefix:MS
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:LEOTTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC, LCADC
Mailing Address - Street 1:PO BOX 110
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08721-0110
Mailing Address - Country:US
Mailing Address - Phone:732-580-6619
Mailing Address - Fax:732-228-7335
Practice Address - Street 1:625 ROUTE 9
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08722-4007
Practice Address - Country:US
Practice Address - Phone:732-580-6619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00453600101YP2500X
NJ101YS0200X
NJ37LC00141500101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool