Provider Demographics
NPI:1376167759
Name:BEAVER, CHRISTIAN JAMES (ACCBC AND CAADE)
Entity Type:Individual
Prefix:MR
First Name:CHRISTIAN
Middle Name:JAMES
Last Name:BEAVER
Suffix:
Gender:M
Credentials:ACCBC AND CAADE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2149 ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:HOLTVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92250
Mailing Address - Country:US
Mailing Address - Phone:442-231-6760
Mailing Address - Fax:
Practice Address - Street 1:2149 ORCHARD RD
Practice Address - Street 2:
Practice Address - City:HOLTVILLE
Practice Address - State:CA
Practice Address - Zip Code:92250
Practice Address - Country:US
Practice Address - Phone:442-231-6760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA7939434101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA91562514C19066OtherSTATE OF CALIFORNIA BENEFITS IDENTIFICATION CARD