Provider Demographics
NPI:1801830773
Name:GARDNER, CHRISTINE RENEE (LCSW, LISW)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:RENEE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:LCSW, LISW
Other - Prefix:MRS
Other - First Name:CHRISTINE
Other - Middle Name:RENEE
Other - Last Name:KUHNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, LISW
Mailing Address - Street 1:5505 LARRY AVENUE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462
Mailing Address - Country:US
Mailing Address - Phone:757-693-2144
Mailing Address - Fax:574-296-7560
Practice Address - Street 1:256 NORTH WITCHDUCK ROAD
Practice Address - Street 2:SUITE G
Practice Address - City:VIRGINA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462
Practice Address - Country:US
Practice Address - Phone:757-693-2144
Practice Address - Fax:574-296-7560
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004406A104100000X, 1041C0700X
VA09040075271041C0700X
OHI99211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000499506OtherANTHEM BCBS #
IN145540PMedicare PIN
INP00615447 RR MEDICARMedicare PIN