Provider Demographics
NPI:1205563673
Name:RIDDLE, CHRISTINA ELIZABETH
Entity type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:ELIZABETH
Last Name:RIDDLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 W GRANT ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47348-1961
Mailing Address - Country:US
Mailing Address - Phone:765-228-8832
Mailing Address - Fax:
Practice Address - Street 1:201 N ILLINOIS ST STE 1600
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-4218
Practice Address - Country:US
Practice Address - Phone:317-558-9410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker