Provider Demographics
NPI:1184350563
Name:PONGRACIC, CHRISTINA (MA, LLPC)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:
Last Name:PONGRACIC
Suffix:
Gender:F
Credentials:MA, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-1525
Mailing Address - Country:US
Mailing Address - Phone:517-610-8110
Mailing Address - Fax:
Practice Address - Street 1:11 E CARLETON RD
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-1619
Practice Address - Country:US
Practice Address - Phone:517-610-8110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451022041101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional