Provider Demographics
NPI:1215500236
Name:PENWELL, CHRISTINE NICOLE (MA LPC)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:NICOLE
Last Name:PENWELL
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 IDEAL ST
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:MI
Mailing Address - Zip Code:48160-1415
Mailing Address - Country:US
Mailing Address - Phone:615-630-0550
Mailing Address - Fax:
Practice Address - Street 1:516 IDEAL ST
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:MI
Practice Address - Zip Code:48160-1415
Practice Address - Country:US
Practice Address - Phone:615-630-0550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7336101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor