Provider Demographics
NPI:1639643497
Name:AUSTIN, CHRISTINA (LCSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:AUSTIN
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 1:115 N LOMBARDY ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-4611
Mailing Address - Country:US
Mailing Address - Phone:571-241-6767
Mailing Address - Fax:
Practice Address - Street 1:2004 BREMO RD STE 201
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-2442
Practice Address - Country:US
Practice Address - Phone:804-272-2000
Practice Address - Fax:804-272-2030
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040108711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0904010871Medicaid