Basic Information
| Provider Information | |||||||||
| NPI: | 1942707708 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRECONIA | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1945 CAROLYN SUE DR | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708155509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2259289398 | ||||||||
| FaxNumber: | 2259289490 | ||||||||
| Practice Location | |||||||||
| Address1: | 27124 HIGHWAY 42 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2256835292 | ||||||||
| FaxNumber: | 2256831310 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2018 | ||||||||
| LastUpdateDate: | 03/25/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 2485458 | 05 | LA | MEDICAID |