Provider Demographics
NPI:1760607907
Name:MESSINA, CHRISTOPHER JAMES SR (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JAMES
Last Name:MESSINA
Suffix:SR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 SKYLARK WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-3033
Mailing Address - Country:US
Mailing Address - Phone:919-846-0603
Mailing Address - Fax:
Practice Address - Street 1:3400 EXECUTIVE DR
Practice Address - Street 2:SUITE 205
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7476
Practice Address - Country:US
Practice Address - Phone:919-878-0900
Practice Address - Fax:919-872-2456
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1101103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000463Medicaid