Individual
CHRISTINA ANNE BANCROFT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D
Contact information
Practice address
1120 15TH ST, AUGUSTA, GA 30912-3341
(706) 721-7874
(706) 721-1793
Mailing address
1120 15TH ST # OR-6000, AUGUSTA, GA 30912-0004
(706) 721-3813
(706) 721-9286
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
11104
NC
101YP2500X
Professional Counselor
A11104
NC
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
PSY004515
GA
Other
Enumeration date
10/06/2014
Last updated
09/16/2021
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