Provider Demographics
NPI:1356738421
Name:CREVELING-BENEFIELD, CHRISTIANE (PHD)
Entity type:Individual
Prefix:DR
First Name:CHRISTIANE
Middle Name:
Last Name:CREVELING-BENEFIELD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CHRISTIANE
Other - Middle Name:
Other - Last Name:CREVELING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:4300 S I 10 SERVICE RD W STE 112
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-7425
Mailing Address - Country:US
Mailing Address - Phone:504-265-7595
Mailing Address - Fax:800-490-8511
Practice Address - Street 1:4300 S I 10 SERVICE RD W STE 112
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-7425
Practice Address - Country:US
Practice Address - Phone:504-265-7595
Practice Address - Fax:800-490-8511
Is Sole Proprietor?:No
Enumeration Date:2015-04-16
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1296103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist