Provider Demographics
NPI:1851285902
Name:RETALLACK, CARINA MARIE (MFT TRAINEE)
Entity type:Individual
Prefix:
First Name:CARINA
Middle Name:MARIE
Last Name:RETALLACK
Suffix:
Gender:F
Credentials:MFT TRAINEE
Other - Prefix:
Other - First Name:CARINA
Other - Middle Name:MARIE
Other - Last Name:SIMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:150 DELLEKER PARK DR
Mailing Address - Street 2:
Mailing Address - City:PORTOLA
Mailing Address - State:CA
Mailing Address - Zip Code:96122-7022
Mailing Address - Country:US
Mailing Address - Phone:530-394-7081
Mailing Address - Fax:
Practice Address - Street 1:1425 E MAIN ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:CA
Practice Address - Zip Code:95971-9402
Practice Address - Country:US
Practice Address - Phone:530-283-3851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist