Provider Demographics
NPI:1023244662
Name:CUNDIFF, CHRISTY M (LPC, PHD CAND)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:M
Last Name:CUNDIFF
Suffix:
Gender:F
Credentials:LPC, PHD CAND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3635 MANASSAS DRIVE, SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014
Mailing Address - Country:US
Mailing Address - Phone:540-774-4686
Mailing Address - Fax:
Practice Address - Street 1:3635 MANASSAS DR
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-4031
Practice Address - Country:US
Practice Address - Phone:540-774-4686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional