Provider Demographics
NPI:1326068636
Name:VERCELLINO, CHRISTINE VERDEEN (LCSW-C)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:VERDEEN
Last Name:VERCELLINO
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3230 E WOODMEN RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-8501
Mailing Address - Country:US
Mailing Address - Phone:301-509-6053
Mailing Address - Fax:
Practice Address - Street 1:16031 COMPRINT CIR
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-1320
Practice Address - Country:US
Practice Address - Phone:301-330-0377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099237621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical