Provider Demographics
NPI:1700140696
Name:MARCHAND, CHRISTOPHER DIETERICH (LCSW)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:DIETERICH
Last Name:MARCHAND
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:793A E. FOOTHILL BLVD
Mailing Address - Street 2:190
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405
Mailing Address - Country:US
Mailing Address - Phone:714-856-0849
Mailing Address - Fax:
Practice Address - Street 1:793A E. FOOTHILL BLVD
Practice Address - Street 2:190
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405
Practice Address - Country:US
Practice Address - Phone:714-856-0849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA236051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical