Provider Demographics
NPI:1528466794
Name:GAGNIER, CHRISTINA LYNN
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:LYNN
Last Name:GAGNIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6583 CONCESSION 6, S, RR#5
Mailing Address - Street 2:
Mailing Address - City:AMHERSTBURG
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:N9V 0C8
Mailing Address - Country:CA
Mailing Address - Phone:519-982-7915
Mailing Address - Fax:
Practice Address - Street 1:13101 ALLEN RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2216
Practice Address - Country:US
Practice Address - Phone:734-785-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3674483104100000X
ZZ819449104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker