Provider Demographics
NPI:1558657205
Name:SMITH, CHRISTINA M (MA)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 S MAIN ST STE F
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97351-2069
Mailing Address - Country:US
Mailing Address - Phone:503-837-0139
Mailing Address - Fax:
Practice Address - Street 1:226 S MAIN ST STE F
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OR
Practice Address - Zip Code:97351-2069
Practice Address - Country:US
Practice Address - Phone:503-837-0139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health