Provider Demographics
NPI:1215256581
Name:FISK, CHRISTINE ELIZABETH (MS LLP)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ELIZABETH
Last Name:FISK
Suffix:
Gender:F
Credentials:MS LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4120 WEST MAPLE ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BLOOMFIELD TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48301
Mailing Address - Country:US
Mailing Address - Phone:248-561-7308
Mailing Address - Fax:248-855-4530
Practice Address - Street 1:4120 WEST MAPLE ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:BLOOMFIELD TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48301
Practice Address - Country:US
Practice Address - Phone:248-561-7308
Practice Address - Fax:248-855-4530
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012916103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist