Basic Information
| Provider Information | |||||||||
| NPI: | 1215125000 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CONKLIN | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | R.A.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 406 SUNRISE AVE | ||||||||
| Address2: | 310 | ||||||||
| City: | ROSEVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956614106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167823737 | ||||||||
| FaxNumber: | 9167823739 | ||||||||
| Practice Location | |||||||||
| Address1: | 406 SUNRISE AVE | ||||||||
| Address2: | 310 | ||||||||
| City: | ROSEVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956614106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167823737 | ||||||||
| FaxNumber: | 9167823739 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2007 | ||||||||
| LastUpdateDate: | 10/05/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | R.A.S. | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YA0400X | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.