Provider Demographics
NPI:1386624294
Name:ROSE, CHRISTINE L (LMFT)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:L
Last Name:ROSE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8333 FOOTHILL BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3156
Mailing Address - Country:US
Mailing Address - Phone:909-771-9185
Mailing Address - Fax:909-579-8250
Practice Address - Street 1:8333 FOOTHILL BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3154
Practice Address - Country:US
Practice Address - Phone:909-579-8205
Practice Address - Fax:909-579-8250
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19001106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA19001OtherPROFESSIONAL LICENSE #