Provider Demographics
NPI:1962927400
Name:CHRISTIE, IRMA (MS,LPC)
Entity type:Individual
Prefix:
First Name:IRMA
Middle Name:
Last Name:CHRISTIE
Suffix:
Gender:F
Credentials:MS,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7160 HUNTERS DR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30028-8904
Mailing Address - Country:US
Mailing Address - Phone:1770-844-7730
Mailing Address - Fax:
Practice Address - Street 1:107 COLONY PARK DR STE 700
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2788
Practice Address - Country:US
Practice Address - Phone:770-733-0934
Practice Address - Fax:770-733-0934
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-05
Last Update Date:2017-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA009693101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional