Provider Demographics
NPI:1558867945
Name:ABBOTT, CHRISTINE (MS, LPC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:FELIX GRAF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:50 ALBANY TPKE STE 3010
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:CT
Mailing Address - Zip Code:06019-2555
Mailing Address - Country:US
Mailing Address - Phone:860-690-9961
Mailing Address - Fax:
Practice Address - Street 1:50 ALBANY TPKE STE 3010
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:CT
Practice Address - Zip Code:06019-2555
Practice Address - Country:US
Practice Address - Phone:860-690-9961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT46.003424101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional