Healthcare Provider Details

I. General information

NPI: 1851828826
Provider Name (Legal Business Name): CHRISTINA L POFF-LONG LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2017
Last Update Date: 12/31/2019
Certification Date: 12/31/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 W 7TH ST STE 200
FREDERICK MD
21701-4106
US

IV. Provider business mailing address

1034 CAPISTRANO CT APT 101
FREDERICK MD
21703-6290
US

V. Phone/Fax

Practice location:
  • Phone: 301-245-6300
  • Fax: 301-682-2539
Mailing address:
  • Phone: 301-988-0924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC6171
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: