Provider Demographics
NPI:1235578311
Name:DECRISTOFERI, DAYNA (LMFT)
Entity Type:Individual
Prefix:MS
First Name:DAYNA
Middle Name:
Last Name:DECRISTOFERI
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 145
Mailing Address - Street 2:
Mailing Address - City:SOULSBYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95372
Mailing Address - Country:US
Mailing Address - Phone:209-604-6606
Mailing Address - Fax:
Practice Address - Street 1:18144 SECO ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:CA
Practice Address - Zip Code:95327-9737
Practice Address - Country:US
Practice Address - Phone:209-984-4820
Practice Address - Fax:209-984-4825
Is Sole Proprietor?:No
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48873106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist