Provider Demographics
NPI:1427023027
Name:CHUKABARAH, CHRISTINE LYNNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:LYNNE
Last Name:CHUKABARAH
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 1:106 SASSER DR
Mailing Address - Street 2:
Mailing Address - City:BONAIRE
Mailing Address - State:GA
Mailing Address - Zip Code:31005-4138
Mailing Address - Country:US
Mailing Address - Phone:478-918-3486
Mailing Address - Fax:
Practice Address - Street 1:100 PAGE RD
Practice Address - Street 2:SUITE D160, WRALC/DPH
Practice Address - City:ROBINS AFB
Practice Address - State:GA
Practice Address - Zip Code:31098-1600
Practice Address - Country:US
Practice Address - Phone:478-327-7680
Practice Address - Fax:478-327-7685
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL1008103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical