Healthcare Provider Details

I. General information

NPI: 1750755740
Provider Name (Legal Business Name): CAROLINA DE ANDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2015
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1682 NOVATO BLVD STE 105
NOVATO CA
94947-0001
US

IV. Provider business mailing address

1682 NOVATO BLVD STE 105
NOVATO CA
94947-0001
US

V. Phone/Fax

Practice location:
  • Phone: 415-473-3240
  • Fax:
Mailing address:
  • Phone: 415-473-3240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number12980
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: