Provider Demographics
NPI:1780085597
Name:FLUKER, CHRISTINA (LMSW, CAADC)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:FLUKER
Suffix:
Gender:F
Credentials:LMSW, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 W FORT ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48226-3007
Mailing Address - Country:US
Mailing Address - Phone:313-963-3434
Mailing Address - Fax:313-963-1832
Practice Address - Street 1:1300 W FORT ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-3007
Practice Address - Country:US
Practice Address - Phone:313-963-3434
Practice Address - Fax:313-963-1832
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIC-02780101YA0400X
MI6801071630104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker