Provider Demographics
NPI:1427274463
Name:REDD, CHRISTINE JOHN (LCSW)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:JOHN
Last Name:REDD
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:LEE
Other - Last Name:REDD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:800 BRADBURY DR SE STE 116
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4310
Mailing Address - Country:US
Mailing Address - Phone:505-272-1476
Mailing Address - Fax:
Practice Address - Street 1:862 AVENIDA PASTORAL NW
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-8304
Practice Address - Country:US
Practice Address - Phone:055-917-5297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34008086A1041C0700X
NMI 62541041S0200X
NMC-062541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM8650021Medicaid