Healthcare Provider Details

I. General information

NPI: 1639768344
Provider Name (Legal Business Name): COUNSELING ASSOCIATES OF MARIN, A LCSW ORGANIZATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2021
Last Update Date: 01/16/2021
Certification Date: 01/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 MILLER AVE STE C
MILL VALLEY CA
94941-2858
US

IV. Provider business mailing address

145 CORTE MADERA TOWN CTR # 124
CORTE MADERA CA
94925-1209
US

V. Phone/Fax

Practice location:
  • Phone: 415-946-9428
  • Fax:
Mailing address:
  • Phone: 415-936-9428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LISA ROBERTSON VEYSSIERE
Title or Position: OWNER
Credential: LCSW
Phone: 415-936-9428