Provider Demographics
NPI:1750603189
Name:SMITH, CHRISTINA A (LCSW)
Entity type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:CHRISTINA
Other - Middle Name:A
Other - Last Name:HARMISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:600 FAYETTE
Mailing Address - Street 2:PO BOX 1346
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61654-1346
Mailing Address - Country:US
Mailing Address - Phone:309-671-8000
Mailing Address - Fax:309-671-8039
Practice Address - Street 1:3400 W NEW LEAF LN
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-3311
Practice Address - Country:US
Practice Address - Phone:309-692-6900
Practice Address - Fax:309-689-3086
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.013816101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional