Provider Demographics
NPI:1801529474
Name:CARREIRA, CHRISTIAN MARK
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:MARK
Last Name:CARREIRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 HARBURY CIR
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72715-6510
Mailing Address - Country:US
Mailing Address - Phone:479-367-0163
Mailing Address - Fax:
Practice Address - Street 1:2601 N WALTON BLVD
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-4302
Practice Address - Country:US
Practice Address - Phone:479-802-4798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician