MEDICARE: DR. CHRISTINA JEAN THAI PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TB0200X	Cognitive & Behavioral Psychologist
2	103TC1900X	Counseling Psychologist
3	103TP2701X	Group Psychotherapy Psychologist
4	103TC0700X	Clinical Psychologist	0810007479	VA

General Provider Information

NPI Number	:	1508433434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTINA JEAN THAI PHD

Provider Business Mailing Address
First Line	:	822 LONG DR APT 356
Second Line	:
City	:	ABERDEEN
State	:	MD
Zip	:	21001-1157
Country	:	US
Telephone Number	:	703-899-5630
Fax Number	:

Provider Business Practice Location Address
First Line	:	59 AVE D
Second Line	:
City	:	PERRY POINT
State	:	MD
Zip	:	21902-0001
Country	:	US
Telephone Number	:	410-642-2411
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2021
Last Update Date	:	06/09/2021

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