Provider Demographics
NPI:1972849412
Name:CARRILLO, CHRISTINA REYNA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:REYNA
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:FOWLER
Mailing Address - State:CA
Mailing Address - Zip Code:93625-2440
Mailing Address - Country:US
Mailing Address - Phone:559-313-8782
Mailing Address - Fax:
Practice Address - Street 1:220 6TH ST.
Practice Address - Street 2:
Practice Address - City:FOWLER
Practice Address - State:CA
Practice Address - Zip Code:93625
Practice Address - Country:US
Practice Address - Phone:559-313-8782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS134341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical