Provider Demographics
NPI:1386345676
Name:CANTERBERRY, CHRISTINE LAURA (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:LAURA
Last Name:CANTERBERRY
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25303-2519
Mailing Address - Country:US
Mailing Address - Phone:304-395-5530
Mailing Address - Fax:
Practice Address - Street 1:1206 VIRGINIA ST E STE 204
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-2937
Practice Address - Country:US
Practice Address - Phone:304-395-5530
Practice Address - Fax:681-245-6369
Is Sole Proprietor?:No
Enumeration Date:2023-03-14
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1085133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered