Provider Demographics
NPI:1033785639
Name:RISNER, CELINA NICHOLE (CDC I)
Entity type:Individual
Prefix:MRS
First Name:CELINA
Middle Name:NICHOLE
Last Name:RISNER
Suffix:
Gender:F
Credentials:CDC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 S CUSHMAN ST
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-6203
Mailing Address - Country:US
Mailing Address - Phone:907-452-8251
Mailing Address - Fax:907-459-3842
Practice Address - Street 1:1521 S CUSHMAN ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-6203
Practice Address - Country:US
Practice Address - Phone:907-452-8251
Practice Address - Fax:907-459-3842
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4599101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)