=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265570329
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTINE MARIE KUJAWA MA NCC LCPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3060 MITCHELLVILLE RD SUITE 212
-----------------------------------------------------
City | BOWIE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20716
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-218-5492
-----------------------------------------------------
Fax | 301-218-9514
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3060 MITCHELLVILLE RD SUITE 212
-----------------------------------------------------
City | BOWIE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20716
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-218-5492
-----------------------------------------------------
Fax | 301-218-9514
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | LC1635
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------