Provider Demographics
NPI:1356540132
Name:WHITLOCK, CRISTINA DOROTHY
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:DOROTHY
Last Name:WHITLOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 2619
Mailing Address - Street 2:
Mailing Address - City:MAMMOTH LAKES
Mailing Address - State:CA
Mailing Address - Zip Code:93546-4001
Mailing Address - Country:US
Mailing Address - Phone:760-914-0754
Mailing Address - Fax:
Practice Address - Street 1:452 OLD MAMMOTH ROAD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:MAMMOTH LAKES
Practice Address - State:CA
Practice Address - Zip Code:93546
Practice Address - Country:US
Practice Address - Phone:760-914-0754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health