Provider Demographics
NPI:1346370152
Name:NORMAN, CHRISTINE CORNWALL (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:CORNWALL
Last Name:NORMAN
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 1:275 E SOUTH TEMPLE STE 101
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-1243
Mailing Address - Country:US
Mailing Address - Phone:801-531-7389
Mailing Address - Fax:801-364-1433
Practice Address - Street 1:275 E SOUTH TEMPLE STE 101
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-1243
Practice Address - Country:US
Practice Address - Phone:801-531-7389
Practice Address - Fax:801-364-1433
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT134425-3501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health