Healthcare Provider Details

I. General information

NPI: 1427887082
Provider Name (Legal Business Name): CHRISTINA POE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2024
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 N PROSPECT AVE STE A
CHAMPAIGN IL
61820-2856
US

IV. Provider business mailing address

805 N PROSPECT AVE STE A
CHAMPAIGN IL
61820-2856
US

V. Phone/Fax

Practice location:
  • Phone: 217-766-9112
  • Fax:
Mailing address:
  • Phone: 217-480-0108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number1427887082
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1427887082
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1427887082
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1427887082
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1427887082
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number1427887082
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: