Provider Demographics
NPI:1275956245
Name:GOTSHALL, CHRISTINE DENISE (MSED)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:DENISE
Last Name:GOTSHALL
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:MRS
Other - First Name:CHRISTINE
Other - Middle Name:DENISE
Other - Last Name:EISLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:974 CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NEW COLUMBIA
Mailing Address - State:PA
Mailing Address - Zip Code:17856-9056
Mailing Address - Country:US
Mailing Address - Phone:570-428-4931
Mailing Address - Fax:
Practice Address - Street 1:434 MARKET ST
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-2403
Practice Address - Country:US
Practice Address - Phone:570-522-0990
Practice Address - Fax:570-522-0971
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH000921101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health