Provider Demographics
NPI:1932197167
Name:ACKERMAN, CRISTINA ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:ANN
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CRISTINA
Other - Middle Name:ANN
Other - Last Name:SCHNEIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NONE
Mailing Address - Street 1:3180 PEGER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-5453
Mailing Address - Country:US
Mailing Address - Phone:907-451-0300
Mailing Address - Fax:907-451-0306
Practice Address - Street 1:3180 PEGER RD
Practice Address - Street 2:SUITE 200
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-5453
Practice Address - Country:US
Practice Address - Phone:907-451-0300
Practice Address - Fax:907-451-0306
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2014-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK594104100000X
AK7381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker