Provider Demographics
NPI:1104075225
Name:DROUILLARD, CHRISTINE RENE (LCSW)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:RENE
Last Name:DROUILLARD
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 1:411 OAK ST
Mailing Address - Street 2:
Mailing Address - City:CINNCINATTI
Mailing Address - State:OH
Mailing Address - Zip Code:45219
Mailing Address - Country:US
Mailing Address - Phone:208-283-8362
Mailing Address - Fax:
Practice Address - Street 1:910 MAIN ST
Practice Address - Street 2:SONNA BLDG, SUITE 231
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5720
Practice Address - Country:US
Practice Address - Phone:208-283-8362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW - 285191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical