Basic Information
Provider Information | |||||||||
NPI: | 1548401037 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DENBOW | ||||||||
FirstName: | CHRISTINE | ||||||||
MiddleName: | M. | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | LPC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | RODGERS | ||||||||
OtherFirstName: | CHRISTINE | ||||||||
OtherMiddleName: | D | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | LPC | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 2000 EOFF ST | ||||||||
Address2: |   | ||||||||
City: | WHEELING | ||||||||
State: | WV | ||||||||
PostalCode: | 260033823 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3042348663 | ||||||||
FaxNumber: | 3042348960 | ||||||||
Practice Location | |||||||||
Address1: | 2101 JACOB ST STE 501 | ||||||||
Address2: |   | ||||||||
City: | WHEELING | ||||||||
State: | WV | ||||||||
PostalCode: | 260033800 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3042348517 | ||||||||
FaxNumber: | 3042348745 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/13/2009 | ||||||||
LastUpdateDate: | 10/15/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 1934 | WV | Y |   | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
ID | Type | State | Issuer | Description | 0005456001 | 05 | WV |   | MEDICAID | Q045898 | 01 | OH | HEALTH PLAN OF THE UPPER OHIO VALLEY | OTHER |