Provider Demographics
NPI:1801467220
Name:DUNHAM, CHRISTINE ALICE (MA)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ALICE
Last Name:DUNHAM
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 594
Mailing Address - Street 2:
Mailing Address - City:POCONO PINES
Mailing Address - State:PA
Mailing Address - Zip Code:18350-0594
Mailing Address - Country:US
Mailing Address - Phone:570-730-7853
Mailing Address - Fax:
Practice Address - Street 1:1151 POCONO BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:COOLBAUGH TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18466
Practice Address - Country:US
Practice Address - Phone:570-243-8787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA10067077101OtherGEISINGER HEALTH INSURANCE ID