Provider Demographics
NPI:1265945307
Name:HUGHBANKS-THOMAS, CHRISTA MARIE (LLMSW)
Entity type:Individual
Prefix:
First Name:CHRISTA
Middle Name:MARIE
Last Name:HUGHBANKS-THOMAS
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:MRS
Other - First Name:CHRISTA
Other - Middle Name:MARIE
Other - Last Name:HUGHBANKS-THOMAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LLMSW, CADC
Mailing Address - Street 1:4925 PACKARD ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1521
Mailing Address - Country:US
Mailing Address - Phone:734-971-9781
Mailing Address - Fax:
Practice Address - Street 1:4925 PACKARD ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1521
Practice Address - Country:US
Practice Address - Phone:734-971-9781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-11
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801101790104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1457565202Medicaid
MI1720307622Medicaid