Provider Demographics
NPI:1659080992
Name:GRIEGO, CHRISTIAN DAWN
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:DAWN
Last Name:GRIEGO
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 1:511 WATERLANE DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-9129
Mailing Address - Country:US
Mailing Address - Phone:432-638-3197
Mailing Address - Fax:
Practice Address - Street 1:511 WATERLANE DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-9129
Practice Address - Country:US
Practice Address - Phone:432-638-3197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108537104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker