Provider Demographics
NPI:1730705526
Name:AJINA, CLAIRE (LEP #3791)
Entity type:Individual
Prefix:MRS
First Name:CLAIRE
Middle Name:
Last Name:AJINA
Suffix:
Gender:F
Credentials:LEP #3791
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3009
Mailing Address - Street 2:
Mailing Address - City:MCKINLEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95519-3009
Mailing Address - Country:US
Mailing Address - Phone:707-499-5969
Mailing Address - Fax:833-248-9195
Practice Address - Street 1:3009 HUBBARD LN STE F
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-4801
Practice Address - Country:US
Practice Address - Phone:707-499-5969
Practice Address - Fax:833-248-9195
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3791103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool