Provider Demographics
NPI:1407877103
Name:SAM, CHRISTINE M (LPC)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:SAM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 140984
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99514-0984
Mailing Address - Country:US
Mailing Address - Phone:907-868-3677
Mailing Address - Fax:844-955-1811
Practice Address - Street 1:1212 H ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-4359
Practice Address - Country:US
Practice Address - Phone:907-868-3677
Practice Address - Fax:844-955-1811
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK434101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMH6578Medicaid