Provider Demographics
NPI:1912181413
Name:STIMSON, CHRISTINA RAE (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:RAE
Last Name:STIMSON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 HERITAGE DRIVE, SUITE 208
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914
Mailing Address - Country:US
Mailing Address - Phone:815-258-1048
Mailing Address - Fax:
Practice Address - Street 1:300 STEEPLECHASE CIR
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-2334
Practice Address - Country:US
Practice Address - Phone:815-258-1048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-20
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0087561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical