Provider Demographics
NPI:1558741785
Name:DEPEW, CHRISTOPHER
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:DEPEW
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 1:116 JEFFERSON ST S STE 208
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-8810
Mailing Address - Country:US
Mailing Address - Phone:256-522-1150
Mailing Address - Fax:
Practice Address - Street 1:116 JEFFERSON ST S STE 208
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-8810
Practice Address - Country:US
Practice Address - Phone:256-522-1150
Practice Address - Fax:844-835-3989
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-03
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC2313A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health