Provider Demographics
NPI:1881124709
Name:MCCONKEY, CHRISTINE ANN (LSW, LCPC)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ANN
Last Name:MCCONKEY
Suffix:
Gender:F
Credentials:LSW, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 EASTERN AVENUE
Mailing Address - Street 2:P.O. BOX 143
Mailing Address - City:DE LAND
Mailing Address - State:IL
Mailing Address - Zip Code:61839
Mailing Address - Country:US
Mailing Address - Phone:217-840-5938
Mailing Address - Fax:
Practice Address - Street 1:4017 ABERDEEN DR
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-8542
Practice Address - Country:US
Practice Address - Phone:217-840-5938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180006545101YP2500X
IL150007229104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional