Provider Demographics
NPI:1801216387
Name:ATANASOVA, CHRISTINA (LICSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:ATANASOVA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:POLACHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 528
Mailing Address - Street 2:ATTN MORGAN HOUSE PROGRAM
Mailing Address - City:BETHEL
Mailing Address - State:AK
Mailing Address - Zip Code:99559-0528
Mailing Address - Country:US
Mailing Address - Phone:907-543-6552
Mailing Address - Fax:907-543-6535
Practice Address - Street 1:200 TER HEUN DR
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-2525
Practice Address - Country:US
Practice Address - Phone:508-540-6550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-23
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1020986Medicaid