Provider Demographics
NPI:1598397119
Name:WOOD, CHRISTINA (LMFT)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:WOOD
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 1:1281 N STATE ST STE 334
Mailing Address - Street 2:
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92583-6313
Mailing Address - Country:US
Mailing Address - Phone:951-884-5559
Mailing Address - Fax:951-350-8196
Practice Address - Street 1:1484 BURNS LN
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-2000
Practice Address - Country:US
Practice Address - Phone:310-413-2934
Practice Address - Fax:951-350-8196
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT115931101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health