| Organization Name: | CHRISTINA STAPLETON, L.L.C |
| NPI Number: | 1003205998 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHRISTINA NICOLE STAPLETON (COUNSELOR) |
| Mailing Address: | 10315 Dawsons Creek Blvd # 12 Fort Wayne |
| State: | IN US |
| Postal Code: | 468251912 |
| Phone Number: | 2603876340 |
| Fax Number: | |
| NPI Enumeration Date: | 01/14/2015 |
| NPI Last Update Date: | 01/14/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM0801X |
| License Number: | 39002095A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
| Taxonomy Definition: | |