Provider Demographics
NPI:1417280546
Name:CHRISTINE C. CANTRELL, PHD, LLC
Entity type:Organization
Organization Name:CHRISTINE C. CANTRELL, PHD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:CLAIRE
Authorized Official - Last Name:CANTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-591-2888
Mailing Address - Street 1:3926 ROYAL AVE STE A
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-3436
Mailing Address - Country:US
Mailing Address - Phone:248-591-2888
Mailing Address - Fax:248-677-3350
Practice Address - Street 1:3926 ROYAL AVE STE A
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-3436
Practice Address - Country:US
Practice Address - Phone:248-591-2888
Practice Address - Fax:248-677-3350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-08
Last Update Date:2021-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009340251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health