Provider Demographics
NPI:1720448608
Name:CHRISTIAN, ROBERT MICHAEL II (LSW, LCDC III)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MICHAEL
Last Name:CHRISTIAN
Suffix:II
Gender:M
Credentials:LSW, LCDC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3975 KENNETH DR
Mailing Address - Street 2:
Mailing Address - City:ROOTSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44272-9252
Mailing Address - Country:US
Mailing Address - Phone:330-850-5141
Mailing Address - Fax:330-850-5349
Practice Address - Street 1:3975 KENNETH DR
Practice Address - Street 2:
Practice Address - City:ROOTSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44272
Practice Address - Country:US
Practice Address - Phone:330-850-5141
Practice Address - Fax:330-850-5349
Is Sole Proprietor?:No
Enumeration Date:2016-03-04
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH161513101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)