Provider Demographics
NPI:1265953293
Name:PIDDINGTON, CHRISTINE M (LCSW)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:PIDDINGTON
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 1:1483 SUNDANCE DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-2014
Mailing Address - Country:US
Mailing Address - Phone:760-218-2816
Mailing Address - Fax:
Practice Address - Street 1:71847 CA-111
Practice Address - Street 2:BLDG A
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270
Practice Address - Country:US
Practice Address - Phone:760-218-2816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-29
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA695211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCSW69521OtherBOARD OF BEHAVIORAL SCIENCES