Provider Demographics
NPI:1043503766
Name:D'AMBROSIO, CHRISTIANNE COOK (MFT)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTIANNE
Middle Name:COOK
Last Name:D'AMBROSIO
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 OCEAN VIS
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-6224
Mailing Address - Country:US
Mailing Address - Phone:949-252-9009
Mailing Address - Fax:949-644-6898
Practice Address - Street 1:26 OCEAN VIS
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-6224
Practice Address - Country:US
Practice Address - Phone:949-252-9009
Practice Address - Fax:949-644-6898
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFCC24387101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor