Provider Demographics
NPI:1912624925
Name:CHRISTOPHERSON, JOHN WAYNE (LMSW, LSW, LCDC-I)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:WAYNE
Last Name:CHRISTOPHERSON
Suffix:
Gender:M
Credentials:LMSW, LSW, LCDC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 QUAIL HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-6078
Mailing Address - Country:US
Mailing Address - Phone:845-392-0969
Mailing Address - Fax:
Practice Address - Street 1:2210 QUAIL HOLLOW DR
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-6078
Practice Address - Country:US
Practice Address - Phone:845-392-0969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5400101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)