Provider Demographics
NPI:1275887754
Name:CHRISTIAN, CHARLENE V
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:V
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15390 E ARIZONA AVE UNIT 307
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80017-4735
Mailing Address - Country:US
Mailing Address - Phone:303-337-0205
Mailing Address - Fax:
Practice Address - Street 1:15390 E ARIZONA AVE UNIT 307
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80017-4735
Practice Address - Country:US
Practice Address - Phone:303-337-0205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health