Healthcare Provider Details

I. General information

NPI: 1215894738
Provider Name (Legal Business Name): MARKETA NOVOSADOVA BOLLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 CAROB LN
ALAMEDA CA
94502-6622
US

IV. Provider business mailing address

202 CAROB LN
ALAMEDA CA
94502-6622
US

V. Phone/Fax

Practice location:
  • Phone: 240-899-9015
  • Fax:
Mailing address:
  • Phone: 240-899-9015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC19978
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: