Provider Demographics
NPI:1841512142
Name:NORTHERN, CHRISTY R L (LCSW)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:R L
Last Name:NORTHERN
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 1:502 CREEK RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-5527
Mailing Address - Country:US
Mailing Address - Phone:502-724-0970
Mailing Address - Fax:
Practice Address - Street 1:727 MOUNT TABOR RD
Practice Address - Street 2:SUITE C
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-6951
Practice Address - Country:US
Practice Address - Phone:502-724-0970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-28
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005858A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical