Provider Demographics
NPI:1295391910
Name:LICHTENBERG, CHRISTAL (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CHRISTAL
Middle Name:
Last Name:LICHTENBERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2528 PRESCOTT CIR E
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80916-3135
Mailing Address - Country:US
Mailing Address - Phone:719-776-0668
Mailing Address - Fax:
Practice Address - Street 1:5353 N UNION BLVD STE 201
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-2065
Practice Address - Country:US
Practice Address - Phone:719-649-1902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-17
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099260061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical