Provider Demographics
NPI:1710577002
Name:COLBURN, CHRISTINA (CDCA)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:COLBURN
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:BLAZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:941 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:PIKETON
Mailing Address - State:OH
Mailing Address - Zip Code:45661-9757
Mailing Address - Country:US
Mailing Address - Phone:740-289-2371
Mailing Address - Fax:740-289-4291
Practice Address - Street 1:715 W EMMITT AVE
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:OH
Practice Address - Zip Code:45690-1015
Practice Address - Country:US
Practice Address - Phone:740-947-8777
Practice Address - Fax:740-947-7728
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.121331101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)