Provider Demographics
NPI:1902137136
Name:SCHULTZ, CHRISTINE ANN (LCSW)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ANN
Last Name:SCHULTZ
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:PO BOX 966
Mailing Address - Street 2:306 W 5TH AV
Mailing Address - City:NOME
Mailing Address - State:AK
Mailing Address - Zip Code:99762-0966
Mailing Address - Country:US
Mailing Address - Phone:907-443-4541
Mailing Address - Fax:
Practice Address - Street 1:306 W 5TH AV
Practice Address - Street 2:NORTON SOUND HEALTH CORPORATION
Practice Address - City:NOME
Practice Address - State:AK
Practice Address - Zip Code:99762-0966
Practice Address - Country:US
Practice Address - Phone:907-443-4541
Practice Address - Fax:907-443-4546
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKLCSW 2591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKLCSW 0259OtherLCSW 0259