Individual
MRS. CHRISTY ALLISON FORKENBROCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A. RAS
Contact information
Practice address
122 MEADOW LANE, MAMMOTH LAKES, CA 93546
(760) 647-6236
Mailing address
PO BOX 3862, MAMMOTH LAKES, CA 93546-3862
(760) 647-6236
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
F0401230924
CA
Other
Enumeration date
01/23/2007
Last updated
07/08/2007
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