Provider Demographics
NPI:1376262337
Name:CONNOLLY, CHRISTINA GABRIEL
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:GABRIEL
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CALVERT TOWNE RD
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-4101
Mailing Address - Country:US
Mailing Address - Phone:410-422-1076
Mailing Address - Fax:
Practice Address - Street 1:69 SHERRY LN
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-3231
Practice Address - Country:US
Practice Address - Phone:443-968-8331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)