Provider Demographics
NPI:1407969991
Name:GOCKMAN, CHRISTINE J (PHD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:J
Last Name:GOCKMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 S RIVER AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-3253
Mailing Address - Country:US
Mailing Address - Phone:616-494-0808
Mailing Address - Fax:616-494-0011
Practice Address - Street 1:246 S RIVER AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-3253
Practice Address - Country:US
Practice Address - Phone:616-494-0808
Practice Address - Fax:616-494-0011
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005808103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist