Provider Demographics
NPI:1518137298
Name:KORTY, CHRISTOPHER ADAM (LCSW)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ADAM
Last Name:KORTY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 LAND ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:STALEY
Mailing Address - State:NC
Mailing Address - Zip Code:27355-8190
Mailing Address - Country:US
Mailing Address - Phone:336-410-2194
Mailing Address - Fax:
Practice Address - Street 1:1750 LAND ESTATES DR
Practice Address - Street 2:
Practice Address - City:STALEY
Practice Address - State:NC
Practice Address - Zip Code:27355-8190
Practice Address - Country:US
Practice Address - Phone:336-410-2194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0068431041C0700X
NCP0037791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
460805400OtherTIN #