Provider Demographics
NPI:1629725759
Name:ADDERLY, CHRISTIANA FOLASHADE
Entity Type:Individual
Prefix:
First Name:CHRISTIANA
Middle Name:FOLASHADE
Last Name:ADDERLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRISTIANA
Other - Middle Name:FOLASHADE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:90 N OAKVIEW DR UNIT 2
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-3152
Mailing Address - Country:US
Mailing Address - Phone:424-351-5132
Mailing Address - Fax:
Practice Address - Street 1:90 N OAKVIEW DR UNIT 2
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-3152
Practice Address - Country:US
Practice Address - Phone:424-351-5132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst