Provider Demographics
NPI:1295781730
Name:REPAY, CHRISTINA EVA (LMSW)
Entity type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:EVA
Last Name:REPAY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31000 TELEGRAPH RD STE 120
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4321
Mailing Address - Country:US
Mailing Address - Phone:248-594-4991
Mailing Address - Fax:
Practice Address - Street 1:31000 TELEGRAPH RD STE 120
Practice Address - Street 2:
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4321
Practice Address - Country:US
Practice Address - Phone:248-594-4991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010739551041C0700X
MI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1295781730Medicaid