Provider Demographics
NPI:1891061016
Name:FOGG, CHRISTINA JOY (LCSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:JOY
Last Name:FOGG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1782
Mailing Address - Country:US
Mailing Address - Phone:765-432-9238
Mailing Address - Fax:
Practice Address - Street 1:300 E MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1782
Practice Address - Country:US
Practice Address - Phone:765-432-9238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-02
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006410A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical