Provider Demographics
NPI:1356076285
Name:D'AMICO, CHRISTOPHER MICHAEL
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:D'AMICO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 HELMSDALE DR
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-4870
Mailing Address - Country:US
Mailing Address - Phone:754-204-6307
Mailing Address - Fax:
Practice Address - Street 1:4000 MURRAY PL
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-5004
Practice Address - Country:US
Practice Address - Phone:434-509-1844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)