Provider Demographics
NPI:1295262566
Name:MONTGOMERY, CHRISTIE LANE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CHRISTIE
Middle Name:LANE
Last Name:MONTGOMERY
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 1:3050 RUE DORLEANS UNIT 274
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-5955
Mailing Address - Country:US
Mailing Address - Phone:505-486-4628
Mailing Address - Fax:
Practice Address - Street 1:731 S HIGHWAY 101 STE 1E
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-2628
Practice Address - Country:US
Practice Address - Phone:858-314-8437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-17
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW76265101YM0800X
CA1042561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health