Healthcare Provider Details

I. General information

NPI: 1679437487
Provider Name (Legal Business Name): MAYA JOANNA KROLIKIEWICZ AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34134 WILD ROSE LN
NORTH FORK CA
93643-9502
US

IV. Provider business mailing address

34134 WILD ROSE LN
NORTH FORK CA
93643-9502
US

V. Phone/Fax

Practice location:
  • Phone: 510-325-7643
  • Fax:
Mailing address:
  • Phone: 510-325-7643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAMFT160361
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: