Provider Demographics
NPI:1275305914
Name:SPURLOCK, CHRISTINA (CDCA)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:SPURLOCK
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4108 WOODCLIFFE AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45420-2851
Mailing Address - Country:US
Mailing Address - Phone:937-312-5151
Mailing Address - Fax:
Practice Address - Street 1:4108 WOODCLIFFE AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45420-2851
Practice Address - Country:US
Practice Address - Phone:937-312-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.180818101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)