Provider Demographics
NPI:1275358541
Name:ODOM, CHRISTINA MARIA (AMFT)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARIA
Last Name:ODOM
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1765 GOODYEAR AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-8026
Mailing Address - Country:US
Mailing Address - Phone:805-718-0104
Mailing Address - Fax:
Practice Address - Street 1:1765 GOODYEAR AVE STE 207
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-8026
Practice Address - Country:US
Practice Address - Phone:805-718-0104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA151260103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling