Provider Demographics
NPI:1972850006
Name:CHRISTIAN, DWIGHT C (CASAC)
Entity Type:Individual
Prefix:MR
First Name:DWIGHT
Middle Name:C
Last Name:CHRISTIAN
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 W 27TH ST FL 6
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6291
Mailing Address - Country:US
Mailing Address - Phone:212-691-2900
Mailing Address - Fax:212-991-0058
Practice Address - Street 1:122 W 27TH ST FL 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6291
Practice Address - Country:US
Practice Address - Phone:212-691-2900
Practice Address - Fax:212-991-0058
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18729101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)