Provider Demographics
NPI:1114040201
Name:ASIMOS, CHRISULA T (PHD)
Entity Type:Individual
Prefix:MS
First Name:CHRISULA
Middle Name:T
Last Name:ASIMOS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-1133
Mailing Address - Country:US
Mailing Address - Phone:415-457-0230
Mailing Address - Fax:
Practice Address - Street 1:23 OAKWOOD DR
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-1133
Practice Address - Country:US
Practice Address - Phone:415-457-0230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor