Provider Demographics
NPI:1982343596
Name:IMADA, CHRISTINA (MA, LPCC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:IMADA
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8280 LA MESA BLVD STE 7
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-6208
Mailing Address - Country:US
Mailing Address - Phone:619-535-8709
Mailing Address - Fax:
Practice Address - Street 1:8280 LA MESA BLVD STE 7
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-6208
Practice Address - Country:US
Practice Address - Phone:619-535-8709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC11337101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health