Healthcare Provider Details

I. General information

NPI: 1982137345
Provider Name (Legal Business Name): NORTH COAST FAMILY COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 04/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 H ST STE 9
CRESCENT CITY CA
95531-3723
US

IV. Provider business mailing address

900 NORTHCREST DR # 28
CRESCENT CITY CA
95531-2315
US

V. Phone/Fax

Practice location:
  • Phone: 707-633-4154
  • Fax:
Mailing address:
  • Phone: 707-633-4154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number98897
License Number StateCA

VIII. Authorized Official

Name: BERNADETTE MARIE JOHNSON
Title or Position: OWNER
Credential: MFT
Phone: 707-633-4154