Individual
MS. CHRISTINE ANN MOTHERWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LMHC, LCSW
Contact information
Practice address
2100 GOSHEN RD, 260, FORT WAYNE, IN 46808-1493
(260) 471-3500
(260) 471-4263
Mailing address
2422 PRESTON DR, FORT WAYNE, IN 46815-6852
(260) 602-5612
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34004390A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100156770A
—
IN
05
—
200283190A
—
IN
Enumeration date
07/20/2005
Last updated
12/06/2019
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