Individual
MRS. CHRISTINE RENEE GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, LISW
Contact information
Practice address
256 NORTH WITCHDUCK ROAD, SUITE G, VIRGINA BEACH, VA 23462
(757) 693-2144
(574) 296-7560
Mailing address
5505 LARRY AVENUE, VIRGINIA BEACH, VA 23462
(757) 693-2144
(574) 296-7560
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
34004406A
IN
1041C0700X
Clinical Social Worker
Primary
0904007527
VA
1041C0700X
Clinical Social Worker
34004406A
IN
1041C0700X
Clinical Social Worker
I9921
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000499506
ANTHEM BCBS #
IN
Enumeration date
06/15/2006
Last updated
02/12/2014
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