Provider Demographics
NPI:1942534482
Name:METTS-WAKELAND, CHRISTINA M (LMBT)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:M
Last Name:METTS-WAKELAND
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083-6711
Mailing Address - Country:US
Mailing Address - Phone:704-490-5220
Mailing Address - Fax:
Practice Address - Street 1:2601 CANNON BLVD
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083
Practice Address - Country:US
Practice Address - Phone:704-490-5220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC07963225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist