Healthcare Provider Details

I. General information

NPI: 1144015694
Provider Name (Legal Business Name): LISA ANNE MOLBERT LAADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 BIRMINGHAM DR STE 240-A
CARDIFF CA
92007-1757
US

IV. Provider business mailing address

120 BIRMINGHAM DR STE 240-A
CARDIFF CA
92007-1757
US

V. Phone/Fax

Practice location:
  • Phone: 415-846-0689
  • Fax:
Mailing address:
  • Phone: 858-208-0121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLR10460824
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: