Provider Demographics
NPI:1831794114
Name:WILSON, CHRISTINA MARIE (LPC)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARIE
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 MANMOUTH AVENUE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502
Mailing Address - Country:US
Mailing Address - Phone:907-903-5609
Mailing Address - Fax:
Practice Address - Street 1:707 A STREET
Practice Address - Street 2:SUITE 115
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501
Practice Address - Country:US
Practice Address - Phone:907-903-5609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK117461101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health