Provider Demographics
NPI:1649600404
Name:DWYER, CHRISTINE KOMISKE (LCSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:KOMISKE
Last Name:DWYER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:CHRISTINE
Other - Last Name:KOMISKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4581 LIFESTYLE LN
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-4807
Mailing Address - Country:US
Mailing Address - Phone:804-608-9430
Mailing Address - Fax:
Practice Address - Street 1:4581 LIFESTYLE LN
Practice Address - Street 2:SUITE 206
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-4807
Practice Address - Country:US
Practice Address - Phone:804-608-9430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-14
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040082961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical