Individual
CHRISTINA LACIVITA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6115 CAMP BOWIE BLVD STE 220, FORT WORTH, TX 76116-5543
(817) 381-0633
Mailing address
6115 CAMP BOWIE BLVD STE 220, FORT WORTH, TX 76116-5543
(817) 381-0633
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
64317
TX
Other
Enumeration date
02/21/2020
Last updated
02/21/2020
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