Healthcare Provider Details

I. General information

NPI: 1922313394
Provider Name (Legal Business Name): MELISSA ANN CHRISTENSEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2010
Last Update Date: 05/07/2020
Certification Date: 05/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9127 BERKVIEW LN
SPRING VALLEY CA
91977-3661
US

IV. Provider business mailing address

823 GATEWAY CENTER WAY
SAN DIEGO CA
92102-4541
US

V. Phone/Fax

Practice location:
  • Phone: 619-289-9337
  • Fax:
Mailing address:
  • Phone: 619-906-4623
  • Fax: 619-906-4564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number69616
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: