Healthcare Provider Details

I. General information

NPI: 1629446752
Provider Name (Legal Business Name): CHRISTINE CARLBERG LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2015
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 W DEL AMO BLVD
LONG BEACH CA
90805-6339
US

IV. Provider business mailing address

PO BOX 609001
SAN DIEGO CA
92160-9001
US

V. Phone/Fax

Practice location:
  • Phone: 951-764-6153
  • Fax:
Mailing address:
  • Phone: 619-528-4600
  • Fax: 619-528-4625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number122602
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: