Provider Demographics
NPI:1033512744
Name:WIEGENSTEIN, CHRISTOPHER J (MS, LMHC, CDP)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:J
Last Name:WIEGENSTEIN
Suffix:
Gender:M
Credentials:MS, LMHC, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 891
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-0891
Mailing Address - Country:US
Mailing Address - Phone:360-682-5519
Mailing Address - Fax:
Practice Address - Street 1:780 SE BAYSHORE DR # 201
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-5701
Practice Address - Country:US
Practice Address - Phone:360-682-5519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-08
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMHC.LH.60814298101YM0800X
WACDP.CP.60814286101YA0400X
MTBBH-LAC-LIC-2637101YA0400X
MTBBH-LCPC-LIC-24040101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)