Provider Demographics
NPI:1861961013
Name:FUENTES, CHRISTINA JOIE ESTHER (RADT)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:JOIE ESTHER
Last Name:FUENTES
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:PO BOX 906
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95415-0906
Mailing Address - Country:US
Mailing Address - Phone:707-510-7934
Mailing Address - Fax:
Practice Address - Street 1:7000B S CENTER DR
Practice Address - Street 2:
Practice Address - City:CLEARLAKE
Practice Address - State:CA
Practice Address - Zip Code:95422-8458
Practice Address - Country:US
Practice Address - Phone:707-994-7090
Practice Address - Fax:707-994-7092
Is Sole Proprietor?:No
Enumeration Date:2018-11-16
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 171M00000X
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)