Provider Demographics
NPI:1578826855
Name:PAPPAFOTIS, CHRISTINA ROSE (PCCI)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ROSE
Last Name:PAPPAFOTIS
Suffix:
Gender:F
Credentials:PCCI
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:R
Other - Last Name:PAPPAFOTIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PCCI
Mailing Address - Street 1:1036 EMERALD ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-2814
Mailing Address - Country:US
Mailing Address - Phone:410-703-3597
Mailing Address - Fax:
Practice Address - Street 1:10717 CAMINO RUIZ
Practice Address - Street 2:SUITE 207
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-2360
Practice Address - Country:US
Practice Address - Phone:858-695-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA669101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional