Provider Demographics
NPI:1124264551
Name:BLINN, CHRISTINE CADWELL (LCSW)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:CADWELL
Last Name:BLINN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:NICOLE
Other - Last Name:CADWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3000 NEW BERN AVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1231
Mailing Address - Country:US
Mailing Address - Phone:919-350-7445
Mailing Address - Fax:919-350-8509
Practice Address - Street 1:3000 NEW BERN AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1231
Practice Address - Country:US
Practice Address - Phone:919-350-7445
Practice Address - Fax:919-350-8509
Is Sole Proprietor?:No
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0054351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106495Medicaid