Provider Demographics
NPI:1811687601
Name:CARSON, CHRISTINABELLA RAE (MA, LAC, SAC, NCC)
Entity type:Individual
Prefix:MISS
First Name:CHRISTINABELLA
Middle Name:RAE
Last Name:CARSON
Suffix:
Gender:F
Credentials:MA, LAC, SAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 POPPER ST
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-5614
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:26 POPPER ST
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-5614
Practice Address - Country:US
Practice Address - Phone:609-808-5280
Practice Address - Fax:609-978-4909
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ01250544101YA0400X
NJ37AC00693200101YM0800X, 101YP2500X
NJ01674660101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool