Basic Information
| Provider Information | |||||||||
| NPI: | 1790921211 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SUBIC | ||||||||
| FirstName: | CHRISTI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 211 BIEDE AVE | ||||||||
| Address2: | |||||||||
| City: | DEFIANCE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435122408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197828856 | ||||||||
| FaxNumber: | 4197822261 | ||||||||
| Practice Location | |||||||||
| Address1: | 211 BIEDE AVE | ||||||||
| Address2: | |||||||||
| City: | DEFIANCE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435122408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197828856 | ||||||||
| FaxNumber: | 4197822261 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2009 | ||||||||
| LastUpdateDate: | 01/06/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | E0500075 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | E.0500075 | 01 | OH | STATE LICENSE | OTHER |