Provider Demographics
NPI:1952694069
Name:KEIM, CHRISTINA (LMHC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:KEIM
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7663 E PORT BAY RD
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:NY
Mailing Address - Zip Code:14590-9516
Mailing Address - Country:US
Mailing Address - Phone:315-398-4681
Mailing Address - Fax:866-686-5366
Practice Address - Street 1:7663 E PORT BAY RD
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:NY
Practice Address - Zip Code:14590-9516
Practice Address - Country:US
Practice Address - Phone:315-398-4681
Practice Address - Fax:866-686-5366
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-23
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005902101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health