Provider Demographics
NPI:1851886139
Name:DOMINIC, CHRISTAVUS (BA, MA)
Entity Type:Individual
Prefix:
First Name:CHRISTAVUS
Middle Name:
Last Name:DOMINIC
Suffix:
Gender:M
Credentials:BA, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 S MAIN ST STE 105
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-1210
Mailing Address - Country:US
Mailing Address - Phone:216-858-0407
Mailing Address - Fax:800-901-0720
Practice Address - Street 1:333 S MAIN ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308
Practice Address - Country:US
Practice Address - Phone:216-858-0407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-28
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker