Provider Demographics
NPI:1851696280
Name:RE, CHRISTIE L (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTIE
Middle Name:L
Last Name:RE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3345 MORAINE DR
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-8108
Mailing Address - Country:US
Mailing Address - Phone:810-623-6096
Mailing Address - Fax:
Practice Address - Street 1:3345 MORAINE DR
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-8108
Practice Address - Country:US
Practice Address - Phone:810-623-6096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-15
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010712031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical