Provider Demographics
NPI:1861266413
Name:THEIS, CHRISTINE (AMFT)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:THEIS
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 ALLEN WAY
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-3905
Mailing Address - Country:US
Mailing Address - Phone:707-494-1301
Mailing Address - Fax:
Practice Address - Street 1:3075 CITRUS CIR # 165101
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2666
Practice Address - Country:US
Practice Address - Phone:707-494-1301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA137210106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty