Provider Demographics
NPI:1861644296
Name:CONNACHER, CHRISTOPHER CHARLES
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:CHARLES
Last Name:CONNACHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 S 3RD ST APT 2
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-1910
Mailing Address - Country:US
Mailing Address - Phone:443-896-8293
Mailing Address - Fax:
Practice Address - Street 1:260 REITZ BLVD STE 5
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9220
Practice Address - Country:US
Practice Address - Phone:443-896-8293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS018169103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling