Provider Demographics
NPI:1891015228
Name:CHRISTINE E. FISK MS LLP PLLC
Entity Type:Organization
Organization Name:CHRISTINE E. FISK MS LLP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MS
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:FISK
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:248-561-7308
Mailing Address - Street 1:4120 WEST MAPLE ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BLOOMFIELD TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48301
Mailing Address - Country:US
Mailing Address - Phone:248-561-7308
Mailing Address - Fax:248-855-4530
Practice Address - Street 1:4120 WEST MAPLE ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:BLOOMFIELD TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48301
Practice Address - Country:US
Practice Address - Phone:248-561-7308
Practice Address - Fax:248-855-4530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-08
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012916103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty