Provider Demographics
NPI:1598411613
Name:DAVISON, CHRISTINA FAULKNER
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:FAULKNER
Last Name:DAVISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 IRON WAY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-1208
Mailing Address - Country:US
Mailing Address - Phone:410-935-4253
Mailing Address - Fax:
Practice Address - Street 1:609 IRON WAY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-1208
Practice Address - Country:US
Practice Address - Phone:410-935-4253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1378173251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health