Provider Demographics
NPI:1669620019
Name:STACH, CHRISTIANE A (MA)
Entity type:Individual
Prefix:MRS
First Name:CHRISTIANE
Middle Name:A
Last Name:STACH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:CHRISTIANE
Other - Middle Name:A
Other - Last Name:MCGUIRT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1875 DRAKE DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-2647
Mailing Address - Country:US
Mailing Address - Phone:510-495-5954
Mailing Address - Fax:
Practice Address - Street 1:2071 ANTIOCH CT STE 204
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-2955
Practice Address - Country:US
Practice Address - Phone:510-495-5954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53699106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist