Provider Demographics
NPI:1194859736
Name:MINOGUCHI, CHRISTINA M (LISW-S, MSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:M
Last Name:MINOGUCHI
Suffix:
Gender:F
Credentials:LISW-S, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3474 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-4056
Mailing Address - Country:US
Mailing Address - Phone:614-604-3475
Mailing Address - Fax:206-338-2103
Practice Address - Street 1:3474 N HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-4056
Practice Address - Country:US
Practice Address - Phone:614-604-3475
Practice Address - Fax:206-338-2103
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00280451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH08258Medicare UPIN