Provider Demographics
NPI:1104613926
Name:LIZAIRE-GANTHIER, CHRIST-LEE
Entity type:Individual
Prefix:
First Name:CHRIST-LEE
Middle Name:
Last Name:LIZAIRE-GANTHIER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5431 CONFEDERATE CAMP CIR SW
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-4755
Mailing Address - Country:US
Mailing Address - Phone:404-931-1797
Mailing Address - Fax:
Practice Address - Street 1:2055 GEES MILL RD NE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-1362
Practice Address - Country:US
Practice Address - Phone:404-931-1797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No171R00000XOther Service ProvidersInterpreter