Provider Demographics
NPI:1306014055
Name:CHRISTIANSEN, ROGER SCOTT
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:SCOTT
Last Name:CHRISTIANSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10767 JAMACHA BLVD SPC 224
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91978-1863
Mailing Address - Country:US
Mailing Address - Phone:619-817-7841
Mailing Address - Fax:
Practice Address - Street 1:10767 JAMACHA BLVD SPC 224
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91978-1863
Practice Address - Country:US
Practice Address - Phone:619-817-7841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)