Provider Demographics
NPI:1184707929
Name:COLF, CHRISTINA JAKSA (LP)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:JAKSA
Last Name:COLF
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:MARIE
Other - Last Name:JAKSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LP
Mailing Address - Street 1:32417 HEARTHSTONE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3473
Mailing Address - Country:US
Mailing Address - Phone:586-944-6379
Mailing Address - Fax:
Practice Address - Street 1:31000 TELEGRAPH RD
Practice Address - Street 2:SUITE 120
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4360
Practice Address - Country:US
Practice Address - Phone:248-594-4991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012781103TC0700X
MI6301014641103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical