Provider Demographics
NPI:1326099318
Name:WELLAND-AKONG, CHRISTAURIA GILLIAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTAURIA
Middle Name:GILLIAN
Last Name:WELLAND-AKONG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:CHRISTAURIA
Other - Middle Name:GILLIAN
Other - Last Name:WELLAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:14356 MARIANOPOLIS WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-4316
Mailing Address - Country:US
Mailing Address - Phone:858-922-8555
Mailing Address - Fax:858-484-7514
Practice Address - Street 1:990 HIGHLAND DR
Practice Address - Street 2:#103
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-2408
Practice Address - Country:US
Practice Address - Phone:858-922-8555
Practice Address - Fax:858-484-7514
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-13
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 17166103TC0700X, 103TC2200X, 103T00000X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA17166Medicaid
CA17166Medicaid