Provider Demographics
NPI:1740337864
Name:WIGHTMAN, CHRISTOPHER D (LCSW)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:D
Last Name:WIGHTMAN
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 1:7033 E TUDOR RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1262
Mailing Address - Country:US
Mailing Address - Phone:907-729-9989
Mailing Address - Fax:907-729-5180
Practice Address - Street 1:4320 DIPLOMACY DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5925
Practice Address - Country:US
Practice Address - Phone:907-729-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKCSWS10921041C0700X
AK10921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK8EM225Medicare PIN
AK8EM228Medicare PIN
AK8EM224Medicare PIN
AK8EM223Medicare PIN
AK8EK289Medicare PIN
AK8EK959Medicare PIN
AK8EM227Medicare PIN
AK8EM226Medicare PIN