Provider Demographics
NPI:1992123848
Name:THOMPSON, CHRISTINA A (LPC,MS,BA)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:A
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LPC,MS,BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 E MAIN ST
Mailing Address - Street 2:4TH FLR ADMINISTRATION
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06702-2310
Mailing Address - Country:US
Mailing Address - Phone:203-574-9000
Mailing Address - Fax:203-574-9006
Practice Address - Street 1:30 CONTROLS DR
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-6157
Practice Address - Country:US
Practice Address - Phone:203-944-0366
Practice Address - Fax:203-753-3274
Is Sole Proprietor?:No
Enumeration Date:2014-03-28
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2704101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTPENDINGMedicaid
PENDINGOtherCAQH