Provider Demographics
NPI:1386981124
Name:NOWAK, CHRISTINE (MED)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:NOWAK
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-1295
Mailing Address - Country:US
Mailing Address - Phone:574-234-3338
Mailing Address - Fax:
Practice Address - Street 1:300 N MICHIGAN ST
Practice Address - Street 2:SUITE 405
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1295
Practice Address - Country:US
Practice Address - Phone:574-234-3338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN870001476A101YA0400X
IN39000487A101YM0800X
IN35001097A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist