Provider Demographics
NPI:1780136580
Name:BRADY, CHRISTINA ARLENE (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:ARLENE
Last Name:BRADY
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MS
Other - First Name:CHRISTINA
Other - Middle Name:ARLENE
Other - Last Name:RODGERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:8121 BOULDER DR
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-8641
Mailing Address - Country:US
Mailing Address - Phone:810-348-4665
Mailing Address - Fax:
Practice Address - Street 1:8121 BOULDER DR
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-8641
Practice Address - Country:US
Practice Address - Phone:810-348-4665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008710101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional