Provider Demographics
NPI:1578848768
Name:CRADDOCK, CHRISTINA E (LCSW)
Entity type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:E
Last Name:CRADDOCK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 HARRY SYKES WAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-1383
Mailing Address - Country:US
Mailing Address - Phone:859-218-3894
Mailing Address - Fax:859-323-2299
Practice Address - Street 1:1135 HARRY SYKES WAY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-1383
Practice Address - Country:US
Practice Address - Phone:859-218-3894
Practice Address - Fax:859-323-2299
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical