Provider Demographics
NPI:1770082547
Name:CHRISTIANSON, DONNA
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:CHRISTIANSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 ARNOLD DR STE C
Mailing Address - Street 2:BOX 148
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-6536
Mailing Address - Country:US
Mailing Address - Phone:925-338-1556
Mailing Address - Fax:
Practice Address - Street 1:223 PEBBLECREEK CT
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-6808
Practice Address - Country:US
Practice Address - Phone:925-338-1556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT128453106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist