Provider Demographics
NPI:1598418170
Name:BERTIAUX, CHRISTOPHER RYAN (MA, LPC, LAC, NCC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:RYAN
Last Name:BERTIAUX
Suffix:
Gender:M
Credentials:MA, LPC, LAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 PARK AVE APT 4306
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-4223
Mailing Address - Country:US
Mailing Address - Phone:843-321-7881
Mailing Address - Fax:
Practice Address - Street 1:285 PARK AVE APT 4306
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4223
Practice Address - Country:US
Practice Address - Phone:843-321-7881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-02
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9636101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional