Provider Demographics
NPI:1669481164
Name:HANEY, CHRISTA GENNEA
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:GENNEA
Last Name:HANEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5777 MADISON AVE
Mailing Address - Street 2:#240
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95841-3315
Mailing Address - Country:US
Mailing Address - Phone:916-344-0964
Mailing Address - Fax:
Practice Address - Street 1:5777 MADISON AVE
Practice Address - Street 2:#240
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841-3315
Practice Address - Country:US
Practice Address - Phone:916-344-0964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47747106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist