Provider Demographics
NPI:1790874774
Name:STAPLETON, CHRISTINA NICOLE (MA)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:NICOLE
Last Name:STAPLETON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3948 NEW VISION DR STE D
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1721
Mailing Address - Country:US
Mailing Address - Phone:260-387-6340
Mailing Address - Fax:260-387-6984
Practice Address - Street 1:3948 NEW VISION DR STE D
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1721
Practice Address - Country:US
Practice Address - Phone:260-407-7285
Practice Address - Fax:260-407-0094
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200530260AMedicaid