Provider Demographics
NPI:1629130943
Name:WITMER, CHRISTOPHER THOMAS (MPA)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:THOMAS
Last Name:WITMER
Suffix:
Gender:M
Credentials:MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 890
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49518-0890
Mailing Address - Country:US
Mailing Address - Phone:616-248-5134
Mailing Address - Fax:
Practice Address - Street 1:3075 ORCHARD VISTA DR SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-7069
Practice Address - Country:US
Practice Address - Phone:616-248-5134
Practice Address - Fax:616-301-8018
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker