Provider Demographics
NPI:1073903050
Name:O'HALLORAN, CHRISTINA (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:
Last Name:O'HALLORAN
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 STOCKTON AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-6219
Mailing Address - Country:US
Mailing Address - Phone:831-818-9664
Mailing Address - Fax:
Practice Address - Street 1:143 STOCKTON AVE
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-6219
Practice Address - Country:US
Practice Address - Phone:831-818-9664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 178481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical