Provider Demographics
NPI:1881009645
Name:NEWSOM, CHRISTIE
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:
Last Name:NEWSOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 HABERSHAM TRCE
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-5999
Mailing Address - Country:US
Mailing Address - Phone:678-414-9459
Mailing Address - Fax:
Practice Address - Street 1:3883 ROGERS BRIDGE RD
Practice Address - Street 2:204 A
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-2802
Practice Address - Country:US
Practice Address - Phone:678-392-1302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007378101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional