Provider Demographics
NPI:1043977432
Name:MARRA, CHRISTINA MARIE (LPC)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARIE
Last Name:MARRA
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 1:103 ED BAYER CT STE 130
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-4046
Mailing Address - Country:US
Mailing Address - Phone:478-333-1660
Mailing Address - Fax:478-245-1052
Practice Address - Street 1:103 ED BAYER CT STE 130
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-4046
Practice Address - Country:US
Practice Address - Phone:478-333-1660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-21
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC012562101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1316537277Medicaid
GA1578881538Medicaid
GA1750932497Medicaid
GA1528612876Medicaid
GA1730605288Medicaid