Provider Demographics
NPI:1639188600
Name:MINCH, CHRISTOPHER CHARLES (MSW)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:CHARLES
Last Name:MINCH
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 SUNRISE DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-8010
Mailing Address - Country:US
Mailing Address - Phone:717-274-3912
Mailing Address - Fax:
Practice Address - Street 1:1700 S. LINCOLN AVENUE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042
Practice Address - Country:US
Practice Address - Phone:717-272-6621
Practice Address - Fax:717-228-6031
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACWO126691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical