Provider Demographics
NPI:1538839477
Name:FIFE, CHRISTINA (LAC)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:FIFE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4931 W YEARLING RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-5416
Mailing Address - Country:US
Mailing Address - Phone:602-989-1468
Mailing Address - Fax:
Practice Address - Street 1:34975 N NORTH VALLEY PKWY STE 152
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85086-4032
Practice Address - Country:US
Practice Address - Phone:602-989-1468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-19750101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health