Healthcare Provider Details

I. General information

NPI: 1043019524
Provider Name (Legal Business Name): MILLBRAE HARMONY HOUSE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

192 AVIADOR AVE
MILLBRAE CA
94030-2752
US

IV. Provider business mailing address

675 3RD LN
SOUTH SAN FRANCISCO CA
94080-3509
US

V. Phone/Fax

Practice location:
  • Phone: 408-890-6437
  • Fax:
Mailing address:
  • Phone: 408-890-6437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: WAIFUNG SIT
Title or Position: OWNER
Credential:
Phone: 408-890-6437