Provider Demographics
NPI:1609399146
Name:LYON, CHRISTOPHER GEORGE (LGSW)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:GEORGE
Last Name:LYON
Suffix:
Gender:M
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 OLD SALISBURY RD
Mailing Address - Street 2:
Mailing Address - City:GRANTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21536-1204
Mailing Address - Country:US
Mailing Address - Phone:724-986-5730
Mailing Address - Fax:
Practice Address - Street 1:200 GLENN ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2573
Practice Address - Country:US
Practice Address - Phone:240-580-1919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20435104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker