Provider Demographics
NPI:1669129177
Name:SHIPLETT, CHRISTIAN MARIE (CDCA)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:MARIE
Last Name:SHIPLETT
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:MARIE
Other - Last Name:SHIPLETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CDCA
Mailing Address - Street 1:316 1/2 TUSCARAWAS AVE NW
Mailing Address - Street 2:
Mailing Address - City:NEW PHILADELPHIA
Mailing Address - State:OH
Mailing Address - Zip Code:44663-1537
Mailing Address - Country:US
Mailing Address - Phone:330-347-9116
Mailing Address - Fax:
Practice Address - Street 1:333 S MAIN ST STE 105
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308-1210
Practice Address - Country:US
Practice Address - Phone:234-334-1223
Practice Address - Fax:234-334-1228
Is Sole Proprietor?:No
Enumeration Date:2022-03-04
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH168513101YA0400X
OH180327101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)