Provider Demographics
NPI:1851614630
Name:ACKERLY, CHRISTINE MARIE (LMHC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MARIE
Last Name:ACKERLY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:MARIE
Other - Last Name:GIRARDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1068 MAIN ST STE 105
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-3659
Mailing Address - Country:US
Mailing Address - Phone:845-231-2155
Mailing Address - Fax:
Practice Address - Street 1:1068 MAIN ST STE 105
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-3659
Practice Address - Country:US
Practice Address - Phone:845-231-2155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002950101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health