Provider Demographics
NPI:1891362083
Name:AYERS, CHRISTINE (MA, PD, NCSP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:AYERS
Suffix:
Gender:F
Credentials:MA, PD, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:968 TOWNLEY AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-7563
Mailing Address - Country:US
Mailing Address - Phone:908-265-6624
Mailing Address - Fax:
Practice Address - Street 1:968 TOWNLEY AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-7563
Practice Address - Country:US
Practice Address - Phone:908-265-6624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-07
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1066569103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool