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Individual

MR. CHRISTIAN JAMES BEAVER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
ACCBC AND CAADE

Contact information

Practice address
2149 ORCHARD RD, HOLTVILLE, CA 92250
(442) 231-6760
Mailing address
2149 ORCHARD RD, HOLTVILLE, CA 92250
(442) 231-6760

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
A7939434
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
91562514C19066
STATE OF CALIFORNIA BENEFITS IDENTIFICATION CARD
CA
Enumeration date
06/02/2020
Last updated
06/02/2020
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