Provider Demographics
NPI:1407176779
Name:BONANNO, CHRISTINA
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:BONANNO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:ELIZABETH
Other - Last Name:MCMILLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:270 COUNTY HOSPITAL RD STE 109
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:CA
Mailing Address - Zip Code:95971-9173
Mailing Address - Country:US
Mailing Address - Phone:530-283-6307
Mailing Address - Fax:530-283-6045
Practice Address - Street 1:270 COUNTY HOSPITAL RD STE 109
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:CA
Practice Address - Zip Code:95971-9173
Practice Address - Country:US
Practice Address - Phone:530-283-6307
Practice Address - Fax:530-283-6045
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-09
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator