Provider Demographics
NPI:1518014554
Name:MICK, CHRISTINA LASHA (LPC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:LASHA
Last Name:MICK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 PLUNK WHITSON RD
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-6795
Mailing Address - Country:US
Mailing Address - Phone:931-528-5396
Mailing Address - Fax:
Practice Address - Street 1:2301 PLUNK WHITSON RD
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-6795
Practice Address - Country:US
Practice Address - Phone:931-528-5396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000001902101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional