Provider Demographics
NPI:1407610819
Name:CHRISCO, KATIE MARIE (LCMHC ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:MARIE
Last Name:CHRISCO
Suffix:
Gender:F
Credentials:LCMHC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 ELON CT
Mailing Address - Street 2:
Mailing Address - City:ELON
Mailing Address - State:NC
Mailing Address - Zip Code:27244-9771
Mailing Address - Country:US
Mailing Address - Phone:336-260-3499
Mailing Address - Fax:
Practice Address - Street 1:2100 ELON CT
Practice Address - Street 2:
Practice Address - City:ELON
Practice Address - State:NC
Practice Address - Zip Code:27244-9771
Practice Address - Country:US
Practice Address - Phone:336-260-3499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19621101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health