Provider Demographics
NPI:1871294140
Name:JUSTICE, CHRISTINE
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:JUSTICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CRISSY
Other - Middle Name:
Other - Last Name:JUSTICE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED, NCC, LPC
Mailing Address - Street 1:PO BOX 177
Mailing Address - Street 2:
Mailing Address - City:SARAH ANN
Mailing Address - State:WV
Mailing Address - Zip Code:25644-0177
Mailing Address - Country:US
Mailing Address - Phone:304-784-3835
Mailing Address - Fax:
Practice Address - Street 1:313 HUDGINS ST
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-3535
Practice Address - Country:US
Practice Address - Phone:304-784-3835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2600101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor