Provider Demographics
NPI:1447910815
Name:NELSON, CHRISTINA ELIZABETH (RADT)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ELIZABETH
Last Name:NELSON
Suffix:
Gender:F
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2635 YORBA LINDA BLVD APT 130
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-1664
Mailing Address - Country:US
Mailing Address - Phone:714-278-7456
Mailing Address - Fax:
Practice Address - Street 1:451 W LAMBERT RD STE 212
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-3920
Practice Address - Country:US
Practice Address - Phone:949-293-6249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty