Provider Demographics
NPI:1689608580
Name:RIDLEY, CHRISTINE L (MSW, LCSW, QCSW)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:L
Last Name:RIDLEY
Suffix:
Gender:F
Credentials:MSW, LCSW, QCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1787 HALE O KEA ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-5946
Mailing Address - Country:US
Mailing Address - Phone:808-959-5911
Mailing Address - Fax:
Practice Address - Street 1:1787 HALE O KEA ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-5946
Practice Address - Country:US
Practice Address - Phone:808-959-5911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW 3318174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist