Provider Demographics
NPI:1750582011
Name:BELLAVITA, CHRISTINE LYNN (BS QMHA)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:LYNN
Last Name:BELLAVITA
Suffix:
Gender:F
Credentials:BS QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 NW 39TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:LINCOLN CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97367-4822
Mailing Address - Country:US
Mailing Address - Phone:541-961-6114
Mailing Address - Fax:541-994-3824
Practice Address - Street 1:2015 NW 39TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:LINCOLN CITY
Practice Address - State:OR
Practice Address - Zip Code:97367-4824
Practice Address - Country:US
Practice Address - Phone:541-961-6114
Practice Address - Fax:541-994-3824
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor