Provider Demographics
NPI:1043505829
Name:DEATON, CHRISTINA C
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:C
Last Name:DEATON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 E HOSPITALITY LN STE 330
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3546
Mailing Address - Country:US
Mailing Address - Phone:707-563-1312
Mailing Address - Fax:
Practice Address - Street 1:560 E HOSPITALITY LN STE 330
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3546
Practice Address - Country:US
Practice Address - Phone:707-563-1312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF71703106H00000X
CALMFT96976106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist