Provider Demographics
NPI:1760768378
Name:AVERILL, CHRISTINA (PHD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:AVERILL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:AVERILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:25550 HAWTHORNE BLVD STE 316
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6832
Mailing Address - Country:US
Mailing Address - Phone:310-375-4463
Mailing Address - Fax:
Practice Address - Street 1:25550 HAWTHORNE BLVD STE 316
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6832
Practice Address - Country:US
Practice Address - Phone:310-375-4463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11966103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical