Provider Demographics
NPI:1184899908
Name:CHADWICK, CHRISTINA C (MS, LCPC)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:C
Last Name:CHADWICK
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 E PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-3740
Mailing Address - Country:US
Mailing Address - Phone:443-257-1390
Mailing Address - Fax:
Practice Address - Street 1:30 E PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3740
Practice Address - Country:US
Practice Address - Phone:443-257-1390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2725101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLC2725OtherDEPT.OF HEALTH&MENTAL HYG