Provider Demographics
NPI:1619570504
Name:IGIDBASHIAN, CHRISTOPHER VARTAN (LPC, MT-BC)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:VARTAN
Last Name:IGIDBASHIAN
Suffix:
Gender:M
Credentials:LPC, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:699 STONEGATE CT
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-1396
Mailing Address - Country:US
Mailing Address - Phone:610-316-9883
Mailing Address - Fax:
Practice Address - Street 1:780 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-4882
Practice Address - Country:US
Practice Address - Phone:610-892-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-21
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012824101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor