Provider Demographics
NPI:1558554162
Name:DAWES, CRISTINA L (LMFT)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:L
Last Name:DAWES
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 1:28625 S WESTERN AVE UNIT 123
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-0810
Mailing Address - Country:US
Mailing Address - Phone:424-287-9762
Mailing Address - Fax:424-400-5648
Practice Address - Street 1:2500 VIA CABRILLO MRNA STE 200A1
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-7224
Practice Address - Country:US
Practice Address - Phone:424-287-9762
Practice Address - Fax:310-507-0145
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CAMFC45948101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1558554162Medicaid