Provider Demographics
NPI:1720370596
Name:BOTT-SCHMUKER, CHRISTINE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:BOTT-SCHMUKER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:BOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:PO BOX 484
Mailing Address - Street 2:
Mailing Address - City:MATHEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23109-0484
Mailing Address - Country:US
Mailing Address - Phone:757-696-5009
Mailing Address - Fax:866-221-7401
Practice Address - Street 1:299 GREENE RD
Practice Address - Street 2:
Practice Address - City:MATHEWS
Practice Address - State:VA
Practice Address - Zip Code:23109-2227
Practice Address - Country:US
Practice Address - Phone:757-696-5009
Practice Address - Fax:866-221-7401
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005026101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA491064OtherTRICARE
VA12241436OtherCAQH
VA1720370596Medicaid