Provider Demographics
NPI:1477316743
Name:CLARKE, CRISTINA EDITH (MS)
Entity Type:Individual
Prefix:MRS
First Name:CRISTINA
Middle Name:EDITH
Last Name:CLARKE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 CRESTWOLD AVE
Mailing Address - Street 2:
Mailing Address - City:VIEW PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90043-1823
Mailing Address - Country:US
Mailing Address - Phone:310-425-4161
Mailing Address - Fax:
Practice Address - Street 1:714 W OLYMPIC BLVD STE 743
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-1668
Practice Address - Country:US
Practice Address - Phone:310-712-3411
Practice Address - Fax:213-749-1875
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15341101YM0800X
CA143447101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health