Provider Demographics
NPI:1043702061
Name:CHRISTY, LARRY D (CACI-IN PROCESS)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:D
Last Name:CHRISTY
Suffix:
Gender:M
Credentials:CACI-IN PROCESS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1644 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:BARNWELL
Mailing Address - State:SC
Mailing Address - Zip Code:29812-2156
Mailing Address - Country:US
Mailing Address - Phone:803-541-1245
Mailing Address - Fax:803-541-1247
Practice Address - Street 1:1644 JACKSON ST
Practice Address - Street 2:
Practice Address - City:BARNWELL
Practice Address - State:SC
Practice Address - Zip Code:29812-2156
Practice Address - Country:US
Practice Address - Phone:803-541-1245
Practice Address - Fax:803-541-1247
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)