Provider Demographics
NPI:1558667667
Name:NOGUES, CHRISTINE ALEXANDRA (PSYDG)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:ALEXANDRA
Last Name:NOGUES
Suffix:
Gender:F
Credentials:PSYDG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8761 SW 97TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2934
Mailing Address - Country:US
Mailing Address - Phone:786-464-9409
Mailing Address - Fax:
Practice Address - Street 1:160 TRAINING CENTER RD
Practice Address - Street 2:
Practice Address - City:HILLSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24343-5149
Practice Address - Country:US
Practice Address - Phone:276-728-3121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002481103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical