Provider Demographics
NPI:1568771772
Name:HARTLINE, CHRISTINA JO (PHD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:JO
Last Name:HARTLINE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:JO
Other - Last Name:HARTLINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 148
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-0148
Mailing Address - Country:US
Mailing Address - Phone:605-224-5811
Mailing Address - Fax:
Practice Address - Street 1:803 E DAKOTA AVE
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-3312
Practice Address - Country:US
Practice Address - Phone:605-224-5811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD503103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical