Provider Demographics
NPI:1700406048
Name:BENOIT, CHRISTINA NICOLE (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:NICOLE
Last Name:BENOIT
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MRS
Other - First Name:CHRISSY
Other - Middle Name:NICOLE
Other - Last Name:BENOIT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA LPC
Mailing Address - Street 1:5230 6TH STREET FRONTAGE RD E
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-5128
Mailing Address - Country:US
Mailing Address - Phone:217-585-5682
Mailing Address - Fax:217-585-4747
Practice Address - Street 1:5230 6TH STREET FRONTAGE RD E
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-5128
Practice Address - Country:US
Practice Address - Phone:217-585-5682
Practice Address - Fax:217-585-4747
Is Sole Proprietor?:No
Enumeration Date:2020-04-16
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178009841101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional