Provider Demographics
NPI:1578773057
Name:RAFALKO, CHRISTOPHER THOMAS (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:THOMAS
Last Name:RAFALKO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:KIT
Other - Middle Name:THOMAS
Other - Last Name:RAFALKO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:3613 EMBASSY LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-1820
Mailing Address - Country:US
Mailing Address - Phone:703-383-1224
Mailing Address - Fax:
Practice Address - Street 1:800 S VALLEY VIEW BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-4411
Practice Address - Country:US
Practice Address - Phone:702-252-8342
Practice Address - Fax:702-252-8349
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2209-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical