Provider Demographics
NPI:1376383950
Name:DAVID, CHRISTINE ANN (LMFT)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ANN
Last Name:DAVID
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19717 ESTES PATH
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55024-7202
Mailing Address - Country:US
Mailing Address - Phone:952-484-5936
Mailing Address - Fax:
Practice Address - Street 1:158 WATER ST N STE 3
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-2125
Practice Address - Country:US
Practice Address - Phone:507-540-0584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4228101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health