Provider Demographics
NPI:1710045398
Name:CHRISTIE, VIRGINIA C L (NCC, LPCC, CCDVC)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:C L
Last Name:CHRISTIE
Suffix:
Gender:F
Credentials:NCC, LPCC, CCDVC
Other - Prefix:MS
Other - First Name:CHRISTIANA
Other - Middle Name:V L
Other - Last Name:CHRISTIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NCC, LPCC, CCDVC,LAD
Mailing Address - Street 1:2325 CERRILLOS RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-3373
Mailing Address - Country:US
Mailing Address - Phone:505-438-0010
Mailing Address - Fax:505-438-6011
Practice Address - Street 1:1500 5TH ST
Practice Address - Street 2:SUITE 4
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-3480
Practice Address - Country:US
Practice Address - Phone:505-982-8823
Practice Address - Fax:505-982-6677
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3097101YP2500X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM88007OtherPRESBYTERIAN MEDICAL
NM46159312Medicaid
NM101247OtherVALUE OPTIONS