Provider Demographics
NPI:1659879559
Name:SHRADER, CHRISTINA (MS, LPCC, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:SHRADER
Suffix:
Gender:F
Credentials:MS, LPCC, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 CAVALIER BLVD STE 113
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-5167
Mailing Address - Country:US
Mailing Address - Phone:859-918-5819
Mailing Address - Fax:
Practice Address - Street 1:71 CAVALIER BLVD STE 113
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042
Practice Address - Country:US
Practice Address - Phone:859-918-5819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1801082101YM0800X
KY240038101YM0800X
KY270713101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health