Provider Demographics
NPI:1023344249
Name:LASTINGER, CHRISTIE M (LCSW)
Entity type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:M
Last Name:LASTINGER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3441 CYPRESS MILL RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-2878
Mailing Address - Country:US
Mailing Address - Phone:912-554-8542
Mailing Address - Fax:912-264-5965
Practice Address - Street 1:515 E 63RD ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4300
Practice Address - Country:US
Practice Address - Phone:912-344-9403
Practice Address - Fax:912-354-3036
Is Sole Proprietor?:No
Enumeration Date:2009-10-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA41771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical