Provider Demographics
NPI:1053500298
Name:CUNDIFF, CHRISTINA DIAHANN (LCSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:DIAHANN
Last Name:CUNDIFF
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 DEBBIE DRIVE
Mailing Address - Street 2:
Mailing Address - City:VINE GROVE
Mailing Address - State:KY
Mailing Address - Zip Code:40175
Mailing Address - Country:US
Mailing Address - Phone:502-345-3264
Mailing Address - Fax:
Practice Address - Street 1:104 DEBBIE DRIVE
Practice Address - Street 2:
Practice Address - City:VINE GROVE
Practice Address - State:KY
Practice Address - Zip Code:40175
Practice Address - Country:US
Practice Address - Phone:502-345-3264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4415104100000X
KY30691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker