Healthcare Provider Details

I. General information

NPI: 1447909361
Provider Name (Legal Business Name): CHRISTIE ROVIRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2022
Last Update Date: 03/18/2022
Certification Date: 03/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 WILSON AVE
NOVATO CA
94947-3825
US

IV. Provider business mailing address

PO BOX 1309
MILL VALLEY CA
94942-1309
US

V. Phone/Fax

Practice location:
  • Phone: 415-892-1643
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number131334
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: