Healthcare Provider Details
I. General information
NPI: 1669084505
Provider Name (Legal Business Name): CHRISTIAN GAITSKILL LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 08/21/2020
Last Update Date: 03/29/2025
Certification Date: 03/29/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1100 MAIN ST STE 104
WHEELING WV
26003-2737
US
IV. Provider business mailing address
4629 AICHOLTZ RD STE 2
CINCINNATI OH
45244-1560
US
V. Phone/Fax
- Phone: 304-513-3495
- Fax:
- Phone: 513-752-1555
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 104100000X |
| Taxonomy | Social Worker |
| License Number | S.1600499 |
| License Number State | OH |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 1041C0700X |
| Taxonomy | Clinical Social Worker |
| License Number | CP00946595 |
| License Number State | WV |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: