Provider Demographics
NPI:1003446071
Name:CHRISTY, DAVID (LGCP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:CHRISTY
Suffix:
Gender:M
Credentials:LGCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1734 MARYLAND AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-5804
Mailing Address - Country:US
Mailing Address - Phone:877-674-2843
Mailing Address - Fax:
Practice Address - Street 1:1734 MARYLAND AVE STE 200
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-5804
Practice Address - Country:US
Practice Address - Phone:877-674-2843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-18
Last Update Date:2020-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLGPC00633101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health