Provider Demographics
NPI:1407147929
Name:MARTZ, CHRISTINA (BA)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:MARTZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:SWAFFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:PO BOX 753722
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99775-3722
Mailing Address - Country:US
Mailing Address - Phone:907-699-4355
Mailing Address - Fax:
Practice Address - Street 1:1270 SUMMET DRIVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709
Practice Address - Country:US
Practice Address - Phone:907-699-4355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-02
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health