Individual
CHRISTINA BOURNIQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2440 DAWNLIGHT AVE, COLUMBUS, OH 43211-1934
(614) 301-2714
Mailing address
2440 DAWNLIGHT AVE, COLUMBUS, OH 43211-1934
(614) 301-2714
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
ICDC.101143-CS
OH
101YM0800X
Mental Health Counselor
Primary
E.1100046-SUPV
OH
Other
Enumeration date
02/12/2016
Last updated
02/12/2016
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