Provider Demographics
NPI:1144680638
Name:JOHNSEN, CHRISTINE (LPCC)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:JOHNSEN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:SHOVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMHC, NCC
Mailing Address - Street 1:10700 ACADEMY RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-7378
Mailing Address - Country:US
Mailing Address - Phone:505-288-0200
Mailing Address - Fax:
Practice Address - Street 1:10700 ACADEMY RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-7378
Practice Address - Country:US
Practice Address - Phone:505-288-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-26
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2022-0813101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM16809742Medicaid