Provider Demographics
NPI:1922322346
Name:DISTEFANO, CHRISTINA (LPCC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:DISTEFANO
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11401 LORAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-5428
Mailing Address - Country:US
Mailing Address - Phone:216-476-4277
Mailing Address - Fax:
Practice Address - Street 1:2803 AKRON RD
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-7904
Practice Address - Country:US
Practice Address - Phone:330-264-3232
Practice Address - Fax:330-202-3897
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-15
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0004278101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional