Provider Demographics
NPI:1720540461
Name:MASSINGALE, CHRISTINE ANN (CADC I)
Entity Type:Individual
Prefix:MISS
First Name:CHRISTINE
Middle Name:ANN
Last Name:MASSINGALE
Suffix:
Gender:F
Credentials:CADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3955 SALMON RIVER HWY
Mailing Address - Street 2:
Mailing Address - City:OTIS
Mailing Address - State:OR
Mailing Address - Zip Code:97368-9778
Mailing Address - Country:US
Mailing Address - Phone:541-614-4437
Mailing Address - Fax:888-977-2106
Practice Address - Street 1:3955 SALMON RIVER HWY
Practice Address - Street 2:
Practice Address - City:OTIS
Practice Address - State:OR
Practice Address - Zip Code:97368-9778
Practice Address - Country:US
Practice Address - Phone:541-614-4437
Practice Address - Fax:888-977-2106
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21-04-10115101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)