Provider Demographics
NPI:1770637795
Name:FORD, CHRISTINE (LPC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 OLD LA 1
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:LA
Mailing Address - Zip Code:70374
Mailing Address - Country:US
Mailing Address - Phone:985-693-7983
Mailing Address - Fax:985-632-8651
Practice Address - Street 1:127 E 123RD ST
Practice Address - Street 2:
Practice Address - City:GALLIANO
Practice Address - State:LA
Practice Address - Zip Code:70354-4223
Practice Address - Country:US
Practice Address - Phone:985-632-2175
Practice Address - Fax:985-632-8651
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA596101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional