Provider Demographics
NPI:1912115346
Name:DUNGAN, CHRISTINE MARIE (MA)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:MARIE
Last Name:DUNGAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:
Other - Last Name:DUNGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:7 SUMMIT WAY
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-2449
Mailing Address - Country:US
Mailing Address - Phone:707-322-7045
Mailing Address - Fax:
Practice Address - Street 1:7 SUMMIT WAY
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2449
Practice Address - Country:US
Practice Address - Phone:707-322-7045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist