Provider Demographics
NPI:1689802431
Name:MOUTENOT-SMALL, CHRISTOPHER JAMES (MA, MFT)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:JAMES
Last Name:MOUTENOT-SMALL
Suffix:
Gender:M
Credentials:MA, MFT
Other - Prefix:MR
Other - First Name:CHRISTOPHER
Other - Middle Name:JAMES
Other - Last Name:MOUTENOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, MFT
Mailing Address - Street 1:421 PARK ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-4749
Mailing Address - Country:US
Mailing Address - Phone:434-260-3530
Mailing Address - Fax:888-965-4094
Practice Address - Street 1:421 PARK ST
Practice Address - Street 2:SUITE 2
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-4749
Practice Address - Country:US
Practice Address - Phone:434-260-3530
Practice Address - Fax:888-965-4094
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717001309106H00000X
CA53644106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist