Healthcare Provider Details

I. General information

NPI: 1629319215
Provider Name (Legal Business Name): KRISTINA TOWNER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2013
Last Update Date: 03/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MCSP, 4001 HWY 104 ATTN: MENTAL HEALTH SERVICES DEPARTMENT
IONE CA
95640
US

IV. Provider business mailing address

MCSP, 4001 HWY 104, PO BOX 409099 ATTN: MENTAL HEALTH SERVICES DEPARTMENT
IONE CA
95640
US

V. Phone/Fax

Practice location:
  • Phone: 209-274-4911
  • Fax:
Mailing address:
  • Phone: 209-274-4911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS19695
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: