Provider Demographics
NPI:1629397229
Name:CANCLINI, CHRISTOPHER ALLEN (MA)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:ALLEN
Last Name:CANCLINI
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 JAMES WAY STE 180
Mailing Address - Street 2:
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-2891
Mailing Address - Country:US
Mailing Address - Phone:805-598-0631
Mailing Address - Fax:
Practice Address - Street 1:330 JAMES WAY STE 180
Practice Address - Street 2:
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-2891
Practice Address - Country:US
Practice Address - Phone:805-598-0631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-20
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53907106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist