Provider Demographics
NPI:1396014742
Name:JOSEPH, CHRISTINE LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:LYNN
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:CHRISTINE
Other - Middle Name:LYNN
Other - Last Name:JOSEPH-RUSSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:191 LAMAR HALEY PKWY
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-8019
Mailing Address - Country:US
Mailing Address - Phone:770-704-1600
Mailing Address - Fax:
Practice Address - Street 1:191 LAMAR HALEY PKWY
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-8019
Practice Address - Country:US
Practice Address - Phone:770-704-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-14
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY079095-11041C0700X
GACSW0059131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical