Individual
CHRISTINA D MACINNIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, LADC, NCC
Contact information
Practice address
51 SHERMAN HILL RD, BLDG A, STE 202, WOODBURY, CT 06798-3648
(203) 733-2015
(203) 733-2015
Mailing address
51 SHERMAN HILL RD, BLDG A, STE 202, WOODBURY, CT 06798-3648
(203) 733-2015
(203) 733-2015
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
001178
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008064077
—
CT
Enumeration date
08/12/2013
Last updated
03/28/2016
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