Provider Demographics
NPI:1619966397
Name:CHRISTIE, CHRISTINA C (LCSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:C
Last Name:CHRISTIE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:C
Other - Last Name:CESARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:131 FRANKLIN HEALTH CMNS
Mailing Address - Street 2:STE A
Mailing Address - City:FARMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04938-6142
Mailing Address - Country:US
Mailing Address - Phone:207-778-0035
Mailing Address - Fax:207-778-6879
Practice Address - Street 1:131 FRANKLIN HEALTH CMNS
Practice Address - Street 2:STE A
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938-6142
Practice Address - Country:US
Practice Address - Phone:207-778-0035
Practice Address - Fax:207-778-6879
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC3231101YA0400X
MEMC9951104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MES410450099Medicaid