Provider Demographics
NPI:1972664456
Name:WARREN, CHRISTINE (LMFT LICSW)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:
Last Name:WARREN
Suffix:
Gender:F
Credentials:LMFT LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 WILLSON RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55424-1332
Mailing Address - Country:US
Mailing Address - Phone:952-925-3983
Mailing Address - Fax:
Practice Address - Street 1:5200 WILLSON RD
Practice Address - Street 2:SUITE 210
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55424-1332
Practice Address - Country:US
Practice Address - Phone:952-925-3983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLMFT 282106H00000X
MNLICSW 5394104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker