Provider Demographics
NPI:1306811849
Name:CHRISTY, MICHELLE (LICSW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:CHRISTY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 HIGH ST
Mailing Address - Street 2:SUITE 720
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-5429
Mailing Address - Country:US
Mailing Address - Phone:304-319-1451
Mailing Address - Fax:304-599-2848
Practice Address - Street 1:235 HIGH ST
Practice Address - Street 2:SUITE 720
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-5429
Practice Address - Country:US
Practice Address - Phone:304-319-1451
Practice Address - Fax:304-599-2848
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-20
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP009416031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVCH6034041Medicare ID - Type Unspecified