Provider Demographics
NPI:1134170376
Name:CANTRELL, CHRISTINE CLAIRE (PHD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:CLAIRE
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 W 11 MILE RD STE C
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-5403
Mailing Address - Country:US
Mailing Address - Phone:248-591-2888
Mailing Address - Fax:248-547-1936
Practice Address - Street 1:1026 W 11 MILE RD STE C
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-5403
Practice Address - Country:US
Practice Address - Phone:248-591-2888
Practice Address - Fax:248-547-1936
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009340103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical