Provider Demographics
NPI:1295981090
Name:SUSTAETA, CHRISTINA MARIA (LPC)
Entity type:Individual
Prefix:MR
First Name:CHRISTINA
Middle Name:MARIA
Last Name:SUSTAETA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 MOUNTAIN VILLA DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-3754
Mailing Address - Country:US
Mailing Address - Phone:512-825-5337
Mailing Address - Fax:
Practice Address - Street 1:5901 MOUNTAIN VILLA DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3754
Practice Address - Country:US
Practice Address - Phone:512-825-5337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59801101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional