Provider Demographics
NPI:1073690541
Name:CHRISTIANSEN, CHRISTINE SIMONE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:SIMONE
Last Name:CHRISTIANSEN
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 1:3900 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3958
Mailing Address - Country:US
Mailing Address - Phone:804-353-4461
Mailing Address - Fax:804-353-3061
Practice Address - Street 1:3900 W BROAD ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3958
Practice Address - Country:US
Practice Address - Phone:804-353-4461
Practice Address - Fax:804-353-3061
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040059701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical