Provider Demographics
NPI:1639699226
Name:FURNISS, CHRISTIANE KERIMA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTIANE
Middle Name:KERIMA
Last Name:FURNISS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1144 BAYVIEW ST
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-6058
Mailing Address - Country:US
Mailing Address - Phone:707-616-5466
Mailing Address - Fax:
Practice Address - Street 1:1062 G ST STE D
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-5800
Practice Address - Country:US
Practice Address - Phone:707-616-5466
Practice Address - Fax:707-616-5466
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-23
Last Update Date:2017-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW279391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty