Provider Demographics
NPI:1316009053
Name:CHRISTAINSON, LIBBY (LPC009612)
Entity Type:Individual
Prefix:
First Name:LIBBY
Middle Name:
Last Name:CHRISTAINSON
Suffix:
Gender:F
Credentials:LPC009612
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131B TOWNHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512-4625
Mailing Address - Country:US
Mailing Address - Phone:574-221-1393
Mailing Address - Fax:
Practice Address - Street 1:131B TOWNHOUSE DR
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-4625
Practice Address - Country:US
Practice Address - Phone:574-221-1393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87000414A101YA0400X
IN39000270A101YM0800X
GA009612101YP2500X
IN34002589A1041C0700X
GALPC009612101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN11642390OtherCAQH PIN
IN2060534OtherCIGNA
IN11642390OtherCAQH PIN
IN22000000362212OtherANTHEM BC BS
IN488519000OtherMAGELLAN
IN488519000OtherMAGELLAN
IN22000000362212OtherANTHEM BC BS