Provider Demographics
NPI:1760194245
Name:ARP, SERINA CHRISTINE (R1374411219)
Entity Type:Individual
Prefix:
First Name:SERINA
Middle Name:CHRISTINE
Last Name:ARP
Suffix:
Gender:F
Credentials:R1374411219
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49713 GORMAN POST RD
Mailing Address - Street 2:
Mailing Address - City:GORMAN
Mailing Address - State:CA
Mailing Address - Zip Code:93243-9701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:49713 GORMAN POST RD
Practice Address - Street 2:
Practice Address - City:GORMAN
Practice Address - State:CA
Practice Address - Zip Code:93243-9701
Practice Address - Country:US
Practice Address - Phone:661-724-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-16
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1374411219101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR1374411219OtherCCAPP