Provider Demographics
NPI:1295621480
Name:GOERDT, CHRISTINA LEE (MSED, LPCC)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:LEE
Last Name:GOERDT
Suffix:
Gender:F
Credentials:MSED, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 PECAN AVE APT 208
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-2750
Mailing Address - Country:US
Mailing Address - Phone:218-213-8128
Mailing Address - Fax:
Practice Address - Street 1:330 3RD ST S
Practice Address - Street 2:
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792-2632
Practice Address - Country:US
Practice Address - Phone:218-741-5191
Practice Address - Fax:218-741-5369
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC05008101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional