Provider Demographics
NPI:1356678122
Name:MARSTON, CHRISTINE BURNELL (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:BURNELL
Last Name:MARSTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 WILLOW VIEW DR
Mailing Address - Street 2:
Mailing Address - City:ORONO
Mailing Address - State:MN
Mailing Address - Zip Code:55356-4302
Mailing Address - Country:US
Mailing Address - Phone:301-751-3111
Mailing Address - Fax:
Practice Address - Street 1:810 WILLOW VIEW DR
Practice Address - Street 2:
Practice Address - City:ORONO
Practice Address - State:MN
Practice Address - Zip Code:55356-4302
Practice Address - Country:US
Practice Address - Phone:301-751-3111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-15
Last Update Date:2009-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist