Provider Demographics
NPI:1861704488
Name:FAY, CHRISTINA (LCSW, LADC, CCS)
Entity type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:
Last Name:FAY
Suffix:
Gender:F
Credentials:LCSW, LADC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 SAND BAR RD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-5540
Mailing Address - Country:US
Mailing Address - Phone:207-281-2681
Mailing Address - Fax:
Practice Address - Street 1:68 BISHOP ST STE 3
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-2681
Practice Address - Country:US
Practice Address - Phone:207-281-2681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC4524101YA0400X
MECCS4684101YA0400X
MELC112941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)