Provider Demographics
NPI:1962116319
Name:GOMES, CHRISTINA KATHLEEN (AOD COUNSELOR)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:KATHLEEN
Last Name:GOMES
Suffix:
Gender:F
Credentials:AOD COUNSELOR
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:KATHLEEN
Other - Last Name:GOMES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AOD COUNSELOR
Mailing Address - Street 1:19361 BROOKHURST ST SPC 97
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-2968
Mailing Address - Country:US
Mailing Address - Phone:619-277-1240
Mailing Address - Fax:714-375-3796
Practice Address - Street 1:17822 BEACH BLVD STE 278
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-7180
Practice Address - Country:US
Practice Address - Phone:714-375-3795
Practice Address - Fax:714-375-3796
Is Sole Proprietor?:No
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13222101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)