Provider Demographics
NPI:1679842058
Name:RAITZ, CHRISTA CLAUDINE (MA, PC)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:CLAUDINE
Last Name:RAITZ
Suffix:
Gender:F
Credentials:MA, PC
Other - Prefix:
Other - First Name:CHRISTA
Other - Middle Name:CLAUDINE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:2121 7TH ST
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-3803
Mailing Address - Country:US
Mailing Address - Phone:304-485-1721
Mailing Address - Fax:304-485-9203
Practice Address - Street 1:2121 7TH ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-3803
Practice Address - Country:US
Practice Address - Phone:304-485-1721
Practice Address - Fax:304-485-9203
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0900096101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional