1396075818 NPI number — CHRISTINA MCGAUTHIAR LCSW, CDC I

Table of content: CHRISTINA MCGAUTHIAR LCSW, CDC I (NPI 1396075818)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396075818 NPI number — CHRISTINA MCGAUTHIAR LCSW, CDC I

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCGAUTHIAR
Provider First Name:
CHRISTINA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW, CDC I
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396075818
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1675 C ST
Provider Second Line Business Mailing Address:
STE 201
Provider Business Mailing Address City Name:
ANCHORAGE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99501-5153
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-279-9634
Provider Business Mailing Address Fax Number:
907-279-0148

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8012 STEWART MOUNTAIN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAGLE RIVER
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99577-9013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-694-3336
Provider Business Practice Location Address Fax Number:
907-279-0148
Provider Enumeration Date:
01/05/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: 1121 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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