Provider Demographics
NPI:1366786378
Name:COUNTIE, CHRISTINA MARY (BCBA)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARY
Last Name:COUNTIE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:505 N BRAND BLVD
Mailing Address - Street 2:#1000
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1906
Mailing Address - Country:US
Mailing Address - Phone:818-241-6780
Mailing Address - Fax:818-241-6853
Practice Address - Street 1:3180 CROW CANYON PL
Practice Address - Street 2:#208
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1115
Practice Address - Country:US
Practice Address - Phone:925-830-8308
Practice Address - Fax:925-830-8309
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA1-12-12666103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst