Provider Demographics
NPI:1467964023
Name:ROCKHOLT, KRISTINA LYNN (LMFT)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:LYNN
Last Name:ROCKHOLT
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:PO BOX 21
Mailing Address - Street 2:
Mailing Address - City:RESCUE
Mailing Address - State:CA
Mailing Address - Zip Code:95672-0021
Mailing Address - Country:US
Mailing Address - Phone:916-297-0700
Mailing Address - Fax:
Practice Address - Street 1:193 BLUE RAVINE RD
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-4756
Practice Address - Country:US
Practice Address - Phone:916-608-0714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83488106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty