Provider Demographics
NPI:1609518208
Name:MACULLEY, CHRYSTI S (ADT)
Entity Type:Individual
Prefix:
First Name:CHRYSTI
Middle Name:S
Last Name:MACULLEY
Suffix:
Gender:F
Credentials:ADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 REEAND LN
Mailing Address - Street 2:
Mailing Address - City:CHURCH HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21623-1439
Mailing Address - Country:US
Mailing Address - Phone:302-359-7189
Mailing Address - Fax:
Practice Address - Street 1:212 BLUE BALL AVE
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5222
Practice Address - Country:US
Practice Address - Phone:104-620-6077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)