Provider Demographics
NPI:1578811709
Name:GAMBLE, CHRISTINA KOCH (LMFT)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:KOCH
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-1607
Mailing Address - Country:US
Mailing Address - Phone:203-265-5975
Mailing Address - Fax:
Practice Address - Street 1:28 GROVE ST
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-1607
Practice Address - Country:US
Practice Address - Phone:203-641-9311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000648106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist