Provider Demographics
NPI:1063181162
Name:COSSIO, CHRISTINE THOMAS (LCSW)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:THOMAS
Last Name:COSSIO
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SOMDG-SGHQ
Mailing Address - Street 2:113 LIELMANIS AVE.
Mailing Address - City:HURLBURT FIELDD
Mailing Address - State:FL
Mailing Address - Zip Code:32544
Mailing Address - Country:US
Mailing Address - Phone:850-428-6374
Mailing Address - Fax:
Practice Address - Street 1:1 SOMDG-SGHQ
Practice Address - Street 2:113 LIELMANIS AVE.
Practice Address - City:HURLBURT FIELD
Practice Address - State:FL
Practice Address - Zip Code:32544
Practice Address - Country:US
Practice Address - Phone:850-428-6374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-10
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX652131041C0700X
FL237641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical