Provider Demographics
NPI:1245768233
Name:TISON, CHRISTINE JONES (MA, LPCA)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:JONES
Last Name:TISON
Suffix:
Gender:F
Credentials:MA, LPCA
Other - Prefix:MRS
Other - First Name:CHRISTY
Other - Middle Name:JONES
Other - Last Name:TISON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1718 REVERDY OAKS DR
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-6846
Mailing Address - Country:US
Mailing Address - Phone:704-287-0586
Mailing Address - Fax:
Practice Address - Street 1:11535 CARMEL COMMONS BLVD STE 104
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-5314
Practice Address - Country:US
Practice Address - Phone:704-941-6601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-02
Last Update Date:2017-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12123101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty