Provider Demographics
NPI:1174595888
Name:DORMSTETTER-O'KEEFE, CHRISTINA DAWN (LPC)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:DAWN
Last Name:DORMSTETTER-O'KEEFE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:DAWN
Other - Last Name:DORMSTETTER-O'KEEFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:2126 MEMORIAL AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24015-2011
Mailing Address - Country:US
Mailing Address - Phone:540-529-8128
Mailing Address - Fax:540-227-6156
Practice Address - Street 1:2126 MEMORIAL AVE SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24015-2011
Practice Address - Country:US
Practice Address - Phone:703-851-1016
Practice Address - Fax:540-227-6156
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003335101YP2500X
VA07013335101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1366632309Medicaid