Provider Demographics
NPI:1750641569
Name:WIDENER, CHRISTINE A (LCSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:A
Last Name:WIDENER
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:PO BOX 85400
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85754-5400
Mailing Address - Country:US
Mailing Address - Phone:520-904-5113
Mailing Address - Fax:520-624-5464
Practice Address - Street 1:240 N COURT AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85701
Practice Address - Country:US
Practice Address - Phone:520-904-5113
Practice Address - Fax:520-624-5464
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-25
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-130831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical