Provider Demographics
NPI:1447940192
Name:EDMONSON, CHRISTINA (LMSW)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:EDMONSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3211 PATHFINDER WAY
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-0749
Mailing Address - Country:US
Mailing Address - Phone:208-790-0891
Mailing Address - Fax:
Practice Address - Street 1:4066 LUCKY LN
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-7025
Practice Address - Country:US
Practice Address - Phone:208-790-0891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-29958104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker