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General NPI Number Information
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NPI Number | 1518171651
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Entity Type | Individual
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Provider Name | CHRISTOPHER WALLACE DEGN LPC
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Gender | Male
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 95-955 WIKAO STREET
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City | MILILANI
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State | HI
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Zip | 96789
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Country | US
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Telephone | 808-625-3586
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Fax |
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Provider Business Mailing Address
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Address Line | 95-955 WIKAO STREET
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City | MILILANI
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State | HI
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Zip | 96789
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Country | US
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Telephone | 808-625-3586
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 5183
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License Number State | NC
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