Provider Demographics
NPI:1194122549
Name:GULLEY, CHRISTINA (SCHOOL PSYCHOLOGIST)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:GULLEY
Suffix:
Gender:F
Credentials:SCHOOL PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2302 WADE AVENUE
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004
Mailing Address - Country:US
Mailing Address - Phone:440-992-1240
Mailing Address - Fax:441-992-1242
Practice Address - Street 1:2302 WADE AVE
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-9435
Practice Address - Country:US
Practice Address - Phone:440-992-1240
Practice Address - Fax:441-992-1242
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH20654683103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool