Provider Demographics
NPI:1962061028
Name:MAGALONG, CHRISTINE C
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:C
Last Name:MAGALONG
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 1:1051 E LASSEN AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-0777
Mailing Address - Country:US
Mailing Address - Phone:619-207-1810
Mailing Address - Fax:
Practice Address - Street 1:560 COHASSET RD STE 180
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2460
Practice Address - Country:US
Practice Address - Phone:530-891-3277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA99837101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty