Healthcare Provider Details

I. General information

NPI: 1558659771
Provider Name (Legal Business Name): CHRISTINA C HOSSOM LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 07/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 S MAIN ST
NEW CASTLE IN
47362-4218
US

IV. Provider business mailing address

321 S MAIN ST
NEW CASTLE IN
47362-4218
US

V. Phone/Fax

Practice location:
  • Phone: 765-529-3370
  • Fax: 765-529-7269
Mailing address:
  • Phone: 765-529-3370
  • Fax: 765-529-7269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34006286A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: