Provider Demographics
NPI:1942486121
Name:BLOCK, CHRISTINE (LMFT)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:BLOCK
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 1:11720 EL CAMINO REAL STE 250
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2243
Mailing Address - Country:US
Mailing Address - Phone:619-252-9446
Mailing Address - Fax:
Practice Address - Street 1:11720 EL CAMINO REAL STE 250
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2243
Practice Address - Country:US
Practice Address - Phone:619-252-9446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-17
Last Update Date:2024-11-07
Deactivation Date:2019-12-04
Deactivation Code:
Reactivation Date:2021-12-30
Provider Licenses
StateLicense IDTaxonomies
CAMFC42751106H00000X, 106H00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1942486121Medicaid