Provider Demographics
NPI:1194906958
Name:FAIR, CHRISTINE A (LPC, PHD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:A
Last Name:FAIR
Suffix:
Gender:F
Credentials:LPC, PHD
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:A
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2211 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-3637
Mailing Address - Country:US
Mailing Address - Phone:419-740-3052
Mailing Address - Fax:419-893-0475
Practice Address - Street 1:2211 RIVER RD
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-3637
Practice Address - Country:US
Practice Address - Phone:419-740-3052
Practice Address - Fax:419-893-0475
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-21
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-12330101YP2500X
AZ3985103T00000X
HI1197103TC0700X
OH7294103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0163573Medicaid