Provider Demographics
NPI:1285987776
Name:MORRIS, CHRISTINA (LCSW)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:MORRIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5917 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BELOIT
Mailing Address - State:IL
Mailing Address - Zip Code:61080-9268
Mailing Address - Country:US
Mailing Address - Phone:815-985-6106
Mailing Address - Fax:
Practice Address - Street 1:6268 E RIVERSIDE BLVD
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-4418
Practice Address - Country:US
Practice Address - Phone:815-397-2224
Practice Address - Fax:815-397-2225
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-21
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490129841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL214505005Medicare PIN