Provider Demographics
NPI:1124849948
Name:AGOSTO, CHRISTINA MARIA
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARIA
Last Name:AGOSTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 LAKEWIND CT
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27332-0612
Mailing Address - Country:US
Mailing Address - Phone:919-601-4785
Mailing Address - Fax:910-356-9466
Practice Address - Street 1:89 LAKEWIND CT
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27332-0612
Practice Address - Country:US
Practice Address - Phone:919-601-4785
Practice Address - Fax:910-356-9466
Is Sole Proprietor?:No
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC106S00000X
NC1699427757106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician