Provider Demographics
NPI:1578990842
Name:HOPPER, CHRISTIANA MARIE (LCPC)
Entity Type:Individual
Prefix:MS
First Name:CHRISTIANA
Middle Name:MARIE
Last Name:HOPPER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:CHRISTIANA
Other - Middle Name:MARIE
Other - Last Name:FOWLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1942 E CANTRELL ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-3214
Mailing Address - Country:US
Mailing Address - Phone:217-433-6961
Mailing Address - Fax:
Practice Address - Street 1:1942 E CANTRELL ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-3214
Practice Address - Country:US
Practice Address - Phone:217-433-6961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008830101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional