Healthcare Provider Details

I. General information

NPI: 1780627687
Provider Name (Legal Business Name): MARGARITA COLON LPCC13947
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1539 MCHENRY AVE STE A
MODESTO CA
95350-4528
US

IV. Provider business mailing address

5201 GREAT AMERICA PKWY STE 320
SANTA CLARA CA
95054-1140
US

V. Phone/Fax

Practice location:
  • Phone: 209-702-0139
  • Fax:
Mailing address:
  • Phone: 323-205-7088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC13947
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: