Provider Demographics
NPI:1780716357
Name:HILL, CHRISTINA K
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:K
Last Name:HILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:KELLEY
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:610 PASEO
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501
Mailing Address - Country:US
Mailing Address - Phone:505-660-1110
Mailing Address - Fax:
Practice Address - Street 1:128 GRANT AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-2031
Practice Address - Country:US
Practice Address - Phone:505-660-1110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4761101YA0400X
NMI41691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000D3908Medicaid
NM00078108Medicaid