Provider Demographics
NPI:1518158211
Name:MIROV, CHRISTINE MARTIN
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MARTIN
Last Name:MIROV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:ELIZABETH
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1009 SOLANO AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-1617
Mailing Address - Country:US
Mailing Address - Phone:341-688-1121
Mailing Address - Fax:
Practice Address - Street 1:1009 SOLANO AVE UNIT B
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-1617
Practice Address - Country:US
Practice Address - Phone:341-688-1121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X, 174H00000X, 101Y00000X
CA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171400000XOther Service ProvidersHealth & Wellness Coach
No174H00000XOther Service ProvidersHealth Educator
No374J00000XNursing Service Related ProvidersDoula