Provider Demographics
NPI:1114387776
Name:POLTAWSKY, CHRISTINE ELIZABETH (MS,, LCAS)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:ELIZABETH
Last Name:POLTAWSKY
Suffix:
Gender:F
Credentials:MS,, LCAS
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:ELIZABETH
Other - Last Name:CALABRESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCAS
Mailing Address - Street 1:515 CLANTON RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-1309
Mailing Address - Country:US
Mailing Address - Phone:704-332-9001
Mailing Address - Fax:
Practice Address - Street 1:515 CLANTON RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-1309
Practice Address - Country:US
Practice Address - Phone:704-332-9001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-25
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20061101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)