Provider Demographics
NPI:1376631887
Name:HENRICKSON, CHRISTINE GULDAGER (MSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:GULDAGER
Last Name:HENRICKSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:CHRISTINE
Other - Middle Name:LYNN
Other - Last Name:GULDAGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, ACSW, BCD
Mailing Address - Street 1:3621 S STATE ST
Mailing Address - Street 2:700 KMS PLACE
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108
Mailing Address - Country:US
Mailing Address - Phone:734-936-2047
Mailing Address - Fax:
Practice Address - Street 1:1500 E MEDICAL CENTER DR
Practice Address - Street 2:B1 FLOOR CANCER CENTER RECP C
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-5912
Practice Address - Country:US
Practice Address - Phone:734-647-8902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010156191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical