Provider Demographics
NPI:1972258150
Name:AXT, CHRISTINA (MA, LAC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:AXT
Suffix:
Gender:F
Credentials:MA, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 LINDSLEY DR STE 203
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-4456
Mailing Address - Country:US
Mailing Address - Phone:973-998-7900
Mailing Address - Fax:973-998-7910
Practice Address - Street 1:25 LINDSLEY DR STE 203
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-4456
Practice Address - Country:US
Practice Address - Phone:973-998-7900
Practice Address - Fax:973-998-7910
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00627200101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor