Healthcare Provider Details

I. General information

NPI: 1982470449
Provider Name (Legal Business Name): CHRISTINA DAWN COLISTRO MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 W CHERRY AVE APT A
POST FALLS ID
83854-5103
US

IV. Provider business mailing address

317 W CHERRY AVE APT A
POST FALLS ID
83854-5103
US

V. Phone/Fax

Practice location:
  • Phone: 208-403-0039
  • Fax:
Mailing address:
  • Phone: 509-863-3510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC10093
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: