Provider Demographics
NPI:1477848042
Name:COYLE, CHRISTINE K (LPC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:K
Last Name:COYLE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:
Other - Last Name:COYLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:19 RAEMONT RD
Mailing Address - Street 2:
Mailing Address - City:GRANITE SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:10527-1113
Mailing Address - Country:US
Mailing Address - Phone:914-248-5363
Mailing Address - Fax:
Practice Address - Street 1:107 CHURCH HILL RD
Practice Address - Street 2:SUITE 1
Practice Address - City:SANDY HOOK
Practice Address - State:CT
Practice Address - Zip Code:06482-1108
Practice Address - Country:US
Practice Address - Phone:203-270-9888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-12
Last Update Date:2011-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2060101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional