Provider Demographics
NPI:1184072977
Name:JOSTOCK, CHRISTINE (MA, LPC)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:JOSTOCK
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 HERON POINTE CT
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-4186
Mailing Address - Country:US
Mailing Address - Phone:248-251-2020
Mailing Address - Fax:
Practice Address - Street 1:3400 HERON POINTE CT
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-4186
Practice Address - Country:US
Practice Address - Phone:248-251-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-02
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014538101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health