Provider Demographics
NPI:1982378931
Name:STEVENSON, CHRISTINA GAIL (LPC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:GAIL
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:GAIL
Other - Last Name:STEVENSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 1895
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-1463
Mailing Address - Country:US
Mailing Address - Phone:208-798-1646
Mailing Address - Fax:
Practice Address - Street 1:531 BRYDEN AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-4438
Practice Address - Country:US
Practice Address - Phone:208-798-1646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID8243101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health