Provider Demographics
NPI:1770675597
Name:HILDRETH, CHRISTIAN S (PSYD)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:S
Last Name:HILDRETH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 EAST COY SMITH HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:MT VERNON
Mailing Address - State:AL
Mailing Address - Zip Code:36560
Mailing Address - Country:US
Mailing Address - Phone:251-662-6700
Mailing Address - Fax:251-829-5385
Practice Address - Street 1:725 EAST COY SMITH HIGHWAY
Practice Address - Street 2:
Practice Address - City:MT VERNON
Practice Address - State:AL
Practice Address - Zip Code:36560
Practice Address - Country:US
Practice Address - Phone:251-662-6700
Practice Address - Fax:251-829-5385
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1021103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
51522549OtherBCBS
P04894Medicare UPIN