Healthcare Provider Details

I. General information

NPI: 1023625449
Provider Name (Legal Business Name): CHRISTINE-MAI LAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2020
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28310 ROADSIDE DR STE 254
AGOURA HILLS CA
91301-4966
US

IV. Provider business mailing address

28310 ROADSIDE DR STE 254
AGOURA HILLS CA
91301-4966
US

V. Phone/Fax

Practice location:
  • Phone: 747-888-0378
  • Fax:
Mailing address:
  • Phone: 747-888-0378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number22361
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: