Provider Demographics
NPI:1194840785
Name:CHRISTIAN, VERNETTE' ELOISE (MC, IMFT)
Entity Type:Individual
Prefix:MS
First Name:VERNETTE'
Middle Name:ELOISE
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:MC, IMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4240 MENLO AVE APT 18
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-4861
Mailing Address - Country:US
Mailing Address - Phone:619-692-8770
Mailing Address - Fax:619-692-8779
Practice Address - Street 1:1250 MORENA BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3815
Practice Address - Country:US
Practice Address - Phone:619-692-8770
Practice Address - Fax:619-692-8779
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF40229101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health