Provider Demographics
NPI:1316239429
Name:CREIGHTON, CHRISTINE MARIE (MS, LPC, ATR)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MARIE
Last Name:CREIGHTON
Suffix:
Gender:F
Credentials:MS, LPC, ATR
Other - Prefix:MS
Other - First Name:CHRISTINE
Other - Middle Name:MARIE
Other - Last Name:HENDRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10062 HOLLY LN APT 2N
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-1462
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3504 COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1821
Practice Address - Country:US
Practice Address - Phone:847-272-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-07
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178009096101YP2500X
WI2413 - 226101Y00000X
225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2413 - 226OtherMARRIAGE AND FAMILY THERAPY, PROFESSIONAL COUNSELING, AND SOCIAL WORK BOARD
IL178009096OtherILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION, LPC