Provider Demographics
NPI:1790090256
Name:PANNELL, CHRISTINA M (LCSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:M
Last Name:PANNELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:M
Other - Last Name:VENEZIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1316 SOMERVILLE RD SE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-4305
Mailing Address - Country:US
Mailing Address - Phone:256-355-6091
Mailing Address - Fax:
Practice Address - Street 1:4110 US HIGHWAY 31 S
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-1644
Practice Address - Country:US
Practice Address - Phone:256-355-6091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2296C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51112654OtherBLUE CROSS BLUE SHIELD OF AL
AL51112654OtherBLUE CROSS BLUE SHIELD OF AL