Provider Demographics
NPI:1083449268
Name:BOURGUIGNON, CHRISTINA (LMHC)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:
Last Name:BOURGUIGNON
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 1:11794 STATE ROUTE 9W STE C
Mailing Address - Street 2:
Mailing Address - City:WEST COXSACKIE
Mailing Address - State:NY
Mailing Address - Zip Code:12192-3602
Mailing Address - Country:US
Mailing Address - Phone:518-461-0540
Mailing Address - Fax:
Practice Address - Street 1:11794 STATE ROUTE 9W STE C
Practice Address - Street 2:
Practice Address - City:WEST COXSACKIE
Practice Address - State:NY
Practice Address - Zip Code:12192-3602
Practice Address - Country:US
Practice Address - Phone:518-461-0540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006755101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty