Provider Demographics
NPI:1124993373
Name:WAKEMAN, CHRISTINA MARIE (LAC-ST)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARIE
Last Name:WAKEMAN
Suffix:
Gender:F
Credentials:LAC-ST
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:MARIE
Other - Last Name:MAGBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC-ST
Mailing Address - Street 1:914 SE 3RD ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-3926
Mailing Address - Country:US
Mailing Address - Phone:316-263-8807
Mailing Address - Fax:316-263-9681
Practice Address - Street 1:939 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-3608
Practice Address - Country:US
Practice Address - Phone:316-263-8807
Practice Address - Fax:316-263-9681
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-08
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS02001-TS101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty