Healthcare Provider Details

I. General information

NPI: 1023536521
Provider Name (Legal Business Name): CHRISTINA ANN WOLFORD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2017
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 N SILVER ST
SILVER CITY NM
88061-6779
US

IV. Provider business mailing address

PO BOX 325
SILVER CITY NM
88062-0325
US

V. Phone/Fax

Practice location:
  • Phone: 575-956-6131
  • Fax: 575-956-6947
Mailing address:
  • Phone: 575-494-1128
  • Fax: 575-956-6947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-10768
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: