Healthcare Provider Details

I. General information

NPI: 1801387881
Provider Name (Legal Business Name): COUNSELORS PLUS - INDIVIDUAL FAMILY AND RELATIONSHIP COUNSELING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2018
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 PRIMROSE RD STE 208
BURLINGAME CA
94010-4091
US

IV. Provider business mailing address

405 PRIMROSE RD STE 208
BURLINGAME CA
94010-4091
US

V. Phone/Fax

Practice location:
  • Phone: 925-365-6968
  • Fax:
Mailing address:
  • Phone: 925-365-6968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DELLA FERNANDES
Title or Position: CEO
Credential:
Phone: 925-365-6968