Provider Demographics
NPI:1861013054
Name:WILLEFORD, CHRISTINE ELLEN (MFT)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:ELLEN
Last Name:WILLEFORD
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 HAYES ST STE B3
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-2970
Mailing Address - Country:US
Mailing Address - Phone:650-269-5609
Mailing Address - Fax:
Practice Address - Street 1:1350 HAYES ST STE B3
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-2970
Practice Address - Country:US
Practice Address - Phone:650-269-5609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52425106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist