Provider Demographics
NPI:1780269464
Name:SOUDER, CHRISTINA KENT (LMHC)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:KENT
Last Name:SOUDER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:CHRISSY
Other - Middle Name:K
Other - Last Name:SOUDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:214 COMMERCIAL ST STE 103
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-6712
Mailing Address - Country:US
Mailing Address - Phone:908-451-9206
Mailing Address - Fax:
Practice Address - Street 1:5 MIDDLESEX AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:MA
Practice Address - Zip Code:01887-2773
Practice Address - Country:US
Practice Address - Phone:978-658-9889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-14
Last Update Date:2021-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10444101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor