Provider Demographics
NPI:1700185659
Name:STONE-WEISE, CHRISTINA LOUISE (CATC II)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:LOUISE
Last Name:STONE-WEISE
Suffix:
Gender:F
Credentials:CATC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1047
Mailing Address - Country:US
Mailing Address - Phone:559-268-6475
Mailing Address - Fax:559-268-6967
Practice Address - Street 1:1803 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1047
Practice Address - Country:US
Practice Address - Phone:559-268-6475
Practice Address - Fax:559-268-6967
Is Sole Proprietor?:No
Enumeration Date:2011-03-17
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA123109 II101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC6937660OtherDRIVER'S LICENSE