MEDICARE: MISS SEVILLE CHRISTIAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor		CA

General Provider Information

NPI Number	:	1710503420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SEVILLE CHRISTIAN

Provider Business Mailing Address
First Line	:	75 DORE ST APT 107
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94103-3892
Country	:	US
Telephone Number	:	415-574-5189
Fax Number	:

Provider Business Practice Location Address
First Line	:	75 DORE ST APT 107
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94103-3892
Country	:	US
Telephone Number	:	415-574-5189
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2020
Last Update Date	:	06/18/2020

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Directions to “ MISS SEVILLE CHRISTIAN ” Practice Location

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