Healthcare Provider Details

I. General information

NPI: 1114141322
Provider Name (Legal Business Name): CHRISTOPHER BAHAM LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5002 MONUMENT AVE SUITE 201
RICHMOND VA
23230-3634
US

IV. Provider business mailing address

5002 MONUMENT AVE SUITE 201
RICHMOND VA
23230-3634
US

V. Phone/Fax

Practice location:
  • Phone: 804-497-4676
  • Fax:
Mailing address:
  • Phone: 804-497-4676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904005826
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: