Provider Demographics
NPI:1295345700
Name:STEVENS, CHRISTINE (LCPC-C)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 FOREST AVENUE, POST OFFICE BOX 1994
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-1994
Mailing Address - Country:US
Mailing Address - Phone:207-415-9914
Mailing Address - Fax:
Practice Address - Street 1:22 HOWARD ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-5323
Practice Address - Country:US
Practice Address - Phone:207-415-9914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL5203101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health