Provider Demographics
NPI:1215125000
Name:CONKLIN, CHRISTINE ANN (RAS)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:ANN
Last Name:CONKLIN
Suffix:
Gender:F
Credentials:RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 SUNRISE AVE
Mailing Address - Street 2:310
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4106
Mailing Address - Country:US
Mailing Address - Phone:916-782-3737
Mailing Address - Fax:916-782-3739
Practice Address - Street 1:406 SUNRISE AVE
Practice Address - Street 2:310
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4106
Practice Address - Country:US
Practice Address - Phone:916-782-3737
Practice Address - Fax:916-782-3739
Is Sole Proprietor?:No
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR.A.S.101YA0400X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)