Provider Demographics
NPI:1356061162
Name:DEAS, CHRISTINA M (LPC)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:M
Last Name:DEAS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4339 HARTLEY BRIDGE RD # 329
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31216-5641
Mailing Address - Country:US
Mailing Address - Phone:478-918-4618
Mailing Address - Fax:
Practice Address - Street 1:65 ELSA WAY
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:GA
Practice Address - Zip Code:31008-3400
Practice Address - Country:US
Practice Address - Phone:478-918-4618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010530101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty