Provider Demographics
NPI:1568627875
Name:ZIMMERMAN, CHRISTINA LYNN (MA,ATR, LPC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:LYNN
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:MA,ATR, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5105 SE STEELE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-5649
Mailing Address - Country:US
Mailing Address - Phone:503-502-8593
Mailing Address - Fax:503-479-4399
Practice Address - Street 1:1125 SE DIVISION ST STE 207
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-2567
Practice Address - Country:US
Practice Address - Phone:503-502-8593
Practice Address - Fax:503-479-4399
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2376101YM0800X, 101Y00000X
OR06-11-70101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)