=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205876349
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT PARKER CRISTMAN LCSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2006
-----------------------------------------------------
Last Update Date | 08/03/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 523 S MAIN ST
-----------------------------------------------------
City | SALISBURY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28144-5408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-639-9973
-----------------------------------------------------
Fax | 704-639-0869
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 523 S MAIN ST
-----------------------------------------------------
City | SALISBURY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28144-5408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-639-9973
-----------------------------------------------------
Fax | 704-639-0869
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | C000802
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------