Provider Demographics
NPI:1730152596
Name:CHRISTOPHERSON, COREY JAMES (LCSW)
Entity type:Individual
Prefix:MR
First Name:COREY
Middle Name:JAMES
Last Name:CHRISTOPHERSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23733 N 79TH LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-5633
Mailing Address - Country:US
Mailing Address - Phone:623-202-7323
Mailing Address - Fax:
Practice Address - Street 1:7219 N LITCHFIELD RD BLDG 1130
Practice Address - Street 2:
Practice Address - City:GLENDALE LUKE AFB
Practice Address - State:AZ
Practice Address - Zip Code:85309-1529
Practice Address - Country:US
Practice Address - Phone:623-856-3417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-107831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical