Provider Demographics
NPI:1588098032
Name:BARDEL, CHRISTINE ANN (LLPC, CRC)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:ANN
Last Name:BARDEL
Suffix:
Gender:F
Credentials:LLPC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8600 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2142
Mailing Address - Country:US
Mailing Address - Phone:313-875-7601
Mailing Address - Fax:313-875-7622
Practice Address - Street 1:8600 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2142
Practice Address - Country:US
Practice Address - Phone:313-875-7601
Practice Address - Fax:313-875-7622
Is Sole Proprietor?:No
Enumeration Date:2013-09-01
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013056101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional