Provider Demographics
NPI:1477163400
Name:MEREDITH, CHRISTINE RENE (LCSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:RENE
Last Name:MEREDITH
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 1:505 HOVEY ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:TX
Mailing Address - Zip Code:76426-2923
Mailing Address - Country:US
Mailing Address - Phone:940-255-1676
Mailing Address - Fax:
Practice Address - Street 1:505 HOVEY ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:TX
Practice Address - Zip Code:76426-2923
Practice Address - Country:US
Practice Address - Phone:940-255-1676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX521941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty