Provider Demographics
NPI:1114350386
Name:OWEN, CHRISTINE ANNE (BCABA)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:ANNE
Last Name:OWEN
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2804 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-7342
Mailing Address - Country:US
Mailing Address - Phone:804-822-5542
Mailing Address - Fax:
Practice Address - Street 1:2804 E BROAD ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-7342
Practice Address - Country:US
Practice Address - Phone:804-822-5542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0134000039103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst