Provider Demographics
NPI:1639626765
Name:UPTON, CRISTINA MARIE (MA)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:MARIE
Last Name:UPTON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:CRISTINA
Other - Middle Name:MARIE
Other - Last Name:GUBSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AMFT
Mailing Address - Street 1:319 S E ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-5175
Mailing Address - Country:US
Mailing Address - Phone:530-521-1676
Mailing Address - Fax:
Practice Address - Street 1:709 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-2920
Practice Address - Country:US
Practice Address - Phone:530-521-1676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-07
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1639626765Medicaid