Provider Demographics
NPI:1225160401
Name:KEENE, CHRISTINA R (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:R
Last Name:KEENE
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 1:8659 HYDRA LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-1824
Mailing Address - Country:US
Mailing Address - Phone:858-877-3766
Mailing Address - Fax:
Practice Address - Street 1:8659 HYDRA LN
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-1824
Practice Address - Country:US
Practice Address - Phone:858-877-3766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 24921101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9356OtherUNITED BEHAVIORAL HEALTH
CALCS 24921OtherLCSW