Provider Demographics
NPI:1376885434
Name:CHRISTIE, ERIN IRENE
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:IRENE
Last Name:CHRISTIE
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 1:160 MCKENZIE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95066-3114
Mailing Address - Country:US
Mailing Address - Phone:831-535-9386
Mailing Address - Fax:
Practice Address - Street 1:160 MCKENZIE CREEK RD
Practice Address - Street 2:
Practice Address - City:SCOTTS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95066-3114
Practice Address - Country:US
Practice Address - Phone:831-535-9386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health