Provider Demographics
NPI:1881683688
Name:CHRISTOFFERSON CONSULTING
Entity Type:Organization
Organization Name:CHRISTOFFERSON CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER INDEPENDENT PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDI
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHRISTOFFERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:701-665-3030
Mailing Address - Street 1:512 4TH ST NE
Mailing Address - Street 2:STE 11
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-2576
Mailing Address - Country:US
Mailing Address - Phone:701-665-3030
Mailing Address - Fax:701-665-3366
Practice Address - Street 1:512 4TH ST NE
Practice Address - Street 2:STE 11
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-2576
Practice Address - Country:US
Practice Address - Phone:701-665-3030
Practice Address - Fax:701-665-3366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND332104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND13356Medicaid
ND18866Other18866
ND18866Medicare ID - Type Unspecified