Provider Demographics
NPI:1043931421
Name:GREEN, CHRISTINA (MSW CSW-PIP QMHP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:MSW CSW-PIP QMHP
Other - Prefix:
Other - First Name:CHRISTIE
Other - Middle Name:
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:124 SAVOY CIR
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-5110
Mailing Address - Country:US
Mailing Address - Phone:053-812-9206
Mailing Address - Fax:
Practice Address - Street 1:124 SAVOY CIR
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-5110
Practice Address - Country:US
Practice Address - Phone:605-381-2920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-06
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD64621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical