Provider Demographics
NPI:1174908073
Name:CHRISTIAN, JOHN EDWARD (ED M, LADC I)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:EDWARD
Last Name:CHRISTIAN
Suffix:
Gender:M
Credentials:ED M, LADC I
Other - Prefix:
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Mailing Address - Street 1:37 PHIPPS ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-6625
Mailing Address - Country:US
Mailing Address - Phone:617-620-8528
Mailing Address - Fax:617-328-8032
Practice Address - Street 1:1400 HANCOCK ST FL 2
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-5233
Practice Address - Country:US
Practice Address - Phone:617-620-8528
Practice Address - Fax:617-328-8032
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA1981101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)