Provider Demographics
NPI:1225410764
Name:CUSTER, CHRISTIE (LMSW)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:
Last Name:CUSTER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11304 EDGEWATER DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:ALLENDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49401-8499
Mailing Address - Country:US
Mailing Address - Phone:616-892-1070
Mailing Address - Fax:616-892-1073
Practice Address - Street 1:11304 EDGEWATER DR
Practice Address - Street 2:SUITE D
Practice Address - City:ALLENDALE
Practice Address - State:MI
Practice Address - Zip Code:49401-8499
Practice Address - Country:US
Practice Address - Phone:616-892-1070
Practice Address - Fax:616-892-1073
Is Sole Proprietor?:No
Enumeration Date:2015-06-21
Last Update Date:2015-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010808041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical