Healthcare Provider Details

I. General information

NPI: 1679211932
Provider Name (Legal Business Name): CARRIE L CHRISTENSEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2022
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

382 VAN NESS ST
COALINGA CA
93210-1533
US

IV. Provider business mailing address

4411 N CEDAR AVE STE 108
FRESNO CA
93726-2538
US

V. Phone/Fax

Practice location:
  • Phone: 208-805-7228
  • Fax:
Mailing address:
  • Phone: 559-248-1548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW112765
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number138095
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: