Healthcare Provider Details

I. General information

NPI: 1083509871
Provider Name (Legal Business Name): CHRISTOPHER ALAN HARVEY LISW-S, LICDC-CS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2025
Last Update Date: 01/23/2026
Certification Date: 01/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

553 E MANHATTAN BLVD
TOLEDO OH
43608-1216
US

IV. Provider business mailing address

1439 DEVONSHIRE ST
BOWLING GREEN OH
43402-2152
US

V. Phone/Fax

Practice location:
  • Phone: 419-219-7001
  • Fax: 567-316-6462
Mailing address:
  • Phone: 419-250-1427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.031079
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.0700201-SUPV
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801120206
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCS.00001302
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: