Provider Demographics
NPI:1992886550
Name:FAULKNER, CHRISTA L (LPCC)
Entity type:Individual
Prefix:
First Name:CHRISTA
Middle Name:L
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:LPCC
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 98
Mailing Address - Street 2:
Mailing Address - City:BURGIN
Mailing Address - State:KY
Mailing Address - Zip Code:40310-0098
Mailing Address - Country:US
Mailing Address - Phone:502-509-3780
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 98
Practice Address - Street 2:
Practice Address - City:BURGIN
Practice Address - State:KY
Practice Address - Zip Code:40310-0098
Practice Address - Country:US
Practice Address - Phone:502-509-3780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY103674101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1790731081Medicaid