Provider Demographics
NPI:1346406311
Name:CHRISTIE, CHRISTINA NELLENA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:NELLENA
Last Name:CHRISTIE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:CHRISTINA
Other - Middle Name:NELLENA
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1540 SOUTHERN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-1901
Mailing Address - Country:US
Mailing Address - Phone:501-681-4252
Mailing Address - Fax:
Practice Address - Street 1:415 N MCKINLEY ST
Practice Address - Street 2:STE. 500
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-3013
Practice Address - Country:US
Practice Address - Phone:501-664-6632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR173300795Medicaid
AR5V771Medicare PIN