Provider Demographics
NPI:1245663418
Name:MACINNIS, CHRISTINA D (MS, LADC, NCC)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:D
Last Name:MACINNIS
Suffix:
Gender:F
Credentials:MS, LADC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:51 SHERMAN HILL RD
Mailing Address - Street 2:BLDG A, STE 202
Mailing Address - City:WOODBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06798-3648
Mailing Address - Country:US
Mailing Address - Phone:203-733-2015
Mailing Address - Fax:203-733-2015
Practice Address - Street 1:51 SHERMAN HILL RD
Practice Address - Street 2:BLDG A, STE 202
Practice Address - City:WOODBURY
Practice Address - State:CT
Practice Address - Zip Code:06798-3648
Practice Address - Country:US
Practice Address - Phone:203-733-2015
Practice Address - Fax:203-733-2015
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001178101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008064077Medicaid