Provider Demographics
NPI:1780835199
Name:CHRISTI, KIM SUZANNE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:SUZANNE
Last Name:CHRISTI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:SUZANNE
Other - Last Name:MEO DARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:43740 N GROESBECK HWY
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-1139
Mailing Address - Country:US
Mailing Address - Phone:586-469-7629
Mailing Address - Fax:586-469-5404
Practice Address - Street 1:43740 N GROESBECK HWY
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48036-1139
Practice Address - Country:US
Practice Address - Phone:586-469-7629
Practice Address - Fax:586-469-5404
Is Sole Proprietor?:No
Enumeration Date:2008-10-03
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N43770Medicare PIN