Provider Demographics
NPI:1497058325
Name:COMBS, CRISTINA BARBARA (LICSW)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:BARBARA
Last Name:COMBS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 LEXINGTON PKWY N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-4636
Mailing Address - Country:US
Mailing Address - Phone:651-280-2167
Mailing Address - Fax:651-280-3995
Practice Address - Street 1:1165 ARCADE ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-2615
Practice Address - Country:US
Practice Address - Phone:651-772-5555
Practice Address - Fax:651-772-5566
Is Sole Proprietor?:No
Enumeration Date:2010-12-15
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN192851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1497058325Medicaid