Provider Demographics
NPI:1720100092
Name:KONDO-LISTER, CHRISTINE SATOMI (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:SATOMI
Last Name:KONDO-LISTER
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 1:2808 MALLARD LN STE B
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-8770
Mailing Address - Country:US
Mailing Address - Phone:530-621-7583
Mailing Address - Fax:530-295-2713
Practice Address - Street 1:2808 MALLARD LN STE B
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-8770
Practice Address - Country:US
Practice Address - Phone:530-621-7583
Practice Address - Fax:530-295-2713
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 148271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical