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General NPI Number Information
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NPI Number | 1245768233
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Entity Type | Individual
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Provider Name | CHRISTINE JONES TISON MA, LPCA
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Gender | Female
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Dates
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Enumeration Date | 06/02/2017
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Last Update Date | 06/02/2017
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Provider Practice Location Address
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Address Line | 11535 CARMEL COMMONS BLVD STE 104
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City | CHARLOTTE
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State | NC
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Zip | 28226-5314
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Country | US
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Telephone | 704-941-6601
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Fax |
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Provider Business Mailing Address
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Address Line | 1718 REVERDY OAKS DR
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City | MATTHEWS
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State | NC
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Zip | 28105-6846
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Country | US
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Telephone | 704-287-0586
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | A12123
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License Number State | NC
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