Provider Demographics
NPI:1295448322
Name:FORD, CHRISTOPHER (LCMHCA)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:FORD
Suffix:
Gender:M
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 TIMBERLANE DR
Mailing Address - Street 2:
Mailing Address - City:ETOWAH
Mailing Address - State:NC
Mailing Address - Zip Code:28729-9795
Mailing Address - Country:US
Mailing Address - Phone:828-290-0915
Mailing Address - Fax:
Practice Address - Street 1:3601 SWEETEN CREEK RD STE 3
Practice Address - Street 2:
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-2739
Practice Address - Country:US
Practice Address - Phone:828-380-4811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18017101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional