Provider Demographics
NPI:1023328572
Name:SEBASTIAN, CHRISTINE (MA, LLP)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:SEBASTIAN
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 VINCENNES CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-2557
Mailing Address - Country:US
Mailing Address - Phone:248-382-8984
Mailing Address - Fax:
Practice Address - Street 1:31700 W 12 MILE RD
Practice Address - Street 2:SUITE 250
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-4424
Practice Address - Country:US
Practice Address - Phone:248-382-8984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014569103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist