Provider Demographics
NPI:1649742107
Name:CHRISTENSEN, PRISCILA (AC2705)
Entity Type:Individual
Prefix:
First Name:PRISCILA
Middle Name:
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:AC2705
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 E PATAPSCO AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:MD
Mailing Address - Zip Code:21225-1745
Mailing Address - Country:US
Mailing Address - Phone:672-602-6016
Mailing Address - Fax:
Practice Address - Street 1:112 E PATAPSCO AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:MD
Practice Address - Zip Code:21225-1745
Practice Address - Country:US
Practice Address - Phone:667-260-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-21
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC2705101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)