Provider Demographics
NPI:1023766078
Name:SANDUM, CHRISTOPHER WADE
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:WADE
Last Name:SANDUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 S ARIZONA AVE
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-2717
Mailing Address - Country:US
Mailing Address - Phone:480-680-0606
Mailing Address - Fax:
Practice Address - Street 1:3033 S ARIZONA AVE
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-2717
Practice Address - Country:US
Practice Address - Phone:480-680-0606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-13661101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health