Provider Demographics
NPI:1366686032
Name:DELGADO, CHRISTINE RENEE (LCPC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:RENEE
Last Name:DELGADO
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 WHITELAW AVE
Mailing Address - Street 2:
Mailing Address - City:WOOD RIVER
Mailing Address - State:IL
Mailing Address - Zip Code:62095-1911
Mailing Address - Country:US
Mailing Address - Phone:618-251-4225
Mailing Address - Fax:618-251-4586
Practice Address - Street 1:114 WHITELAW AVE
Practice Address - Street 2:
Practice Address - City:WOOD RIVER
Practice Address - State:IL
Practice Address - Zip Code:62095-1911
Practice Address - Country:US
Practice Address - Phone:618-251-4224
Practice Address - Fax:618-251-4586
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-26
Last Update Date:2009-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007056101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health