Provider Demographics
NPI:1659818920
Name:BLACKBURN, CHRISTINE (CADC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51105-1418
Mailing Address - Country:US
Mailing Address - Phone:712-255-0204
Mailing Address - Fax:712-255-1120
Practice Address - Street 1:800 5TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1317
Practice Address - Country:US
Practice Address - Phone:712-234-2382
Practice Address - Fax:712-234-2395
Is Sole Proprietor?:No
Enumeration Date:2017-01-25
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA13015101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)