Provider Demographics
NPI:1376564500
Name:MAYO, CHRISTINA LOUISE (PHD,LLP)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:LOUISE
Last Name:MAYO
Suffix:
Gender:F
Credentials:PHD,LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43996 WOODWARD AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-5028
Mailing Address - Country:US
Mailing Address - Phone:248-338-2988
Mailing Address - Fax:248-338-1322
Practice Address - Street 1:43996 WOODWARD AVE STE 101
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5028
Practice Address - Country:US
Practice Address - Phone:248-338-2988
Practice Address - Fax:248-338-1322
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011657103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical