Healthcare Provider Details

I. General information

NPI: 1588170179
Provider Name (Legal Business Name): CHRISTINA CAUBLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINA SCHMID

II. Dates (important events)

Enumeration Date: 12/19/2017
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15519 CRENSHAW BLVD
GARDENA CA
90249-4525
US

IV. Provider business mailing address

3143 W 180TH ST
TORRANCE CA
90504-4013
US

V. Phone/Fax

Practice location:
  • Phone: 310-679-9126
  • Fax:
Mailing address:
  • Phone: 310-634-3788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC10982
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number8147
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: