Provider Demographics
NPI:1144529082
Name:MCDONNAL, KRISTA CHARLENE (CATC)
Entity type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:CHARLENE
Last Name:MCDONNAL
Suffix:
Gender:F
Credentials:CATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 N JOHNSON AVE
Mailing Address - Street 2:STE # 111
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-1676
Mailing Address - Country:US
Mailing Address - Phone:619-440-4801
Mailing Address - Fax:619-442-1592
Practice Address - Street 1:1365 N JOHNSON AVE
Practice Address - Street 2:STE #111
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-1676
Practice Address - Country:US
Practice Address - Phone:619-440-4801
Practice Address - Fax:619-442-1592
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102464101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)