Provider Demographics
NPI:1912003690
Name:MASON, CHRISTINE C (LCPC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:C
Last Name:MASON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11355 PEMBROOKE SQ STE 108
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4805
Mailing Address - Country:US
Mailing Address - Phone:307-843-6966
Mailing Address - Fax:301-645-7006
Practice Address - Street 1:11355 PEMBROOKE SQ STE 108
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4805
Practice Address - Country:US
Practice Address - Phone:307-843-6966
Practice Address - Fax:301-645-7006
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD-LC0464101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health