Provider Demographics
NPI:1568978450
Name:PREBBLE, CHRISTINE MARIE (MS, BSL, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MARIE
Last Name:PREBBLE
Suffix:
Gender:F
Credentials:MS, BSL, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 S HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:LOCK HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17745-2812
Mailing Address - Country:US
Mailing Address - Phone:570-748-7173
Mailing Address - Fax:570-748-5717
Practice Address - Street 1:120 S HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-2812
Practice Address - Country:US
Practice Address - Phone:570-748-7173
Practice Address - Fax:570-748-5717
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-14
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
PAPC010532101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PABH002730OtherPA STATE BOARD
PAPC010532OtherPA STATE BOARD, PROFESSIONAL COUNSELORS