Healthcare Provider Details

I. General information

NPI: 1689608580
Provider Name (Legal Business Name): CHRISTINE L. RIDLEY MSW, LCSW, QCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1787 HALE O KEA ST
HILO HI
96720-5946
US

IV. Provider business mailing address

1787 HALE O KEA ST
HILO HI
96720-5946
US

V. Phone/Fax

Practice location:
  • Phone: 808-959-5911
  • Fax:
Mailing address:
  • Phone: 808-959-5911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberLCSW 3318
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: