Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | CA | |
Y | 225400000X | Rehabilitation Practitioner | CA |
NPI | 1013361773 |
---|---|
Provider Name | Christina Stephenitch |
First Address | Long Beach, CA 90802-2426 |
Second Address | Long Beach, CA 90802-2426 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2016 |
Last Update Date | 19/04/2016 |