Basic Information
| Provider Information | |||||||||
| NPI: | 1104397421 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAIZLIP | ||||||||
| FirstName: | CHRISTI | ||||||||
| MiddleName: | ANNA | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 N WASHINGTON HWY STE 201 | ||||||||
| Address2: | |||||||||
| City: | ASHLAND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 230051642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042698755 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 201 N WASHINGTON HWY STE 201 | ||||||||
| Address2: | |||||||||
| City: | ASHLAND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 230051642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042698755 | ||||||||
| FaxNumber: | 8667804133 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2018 | ||||||||
| LastUpdateDate: | 12/14/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 0701007774 | VA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.