Healthcare Provider Details

I. General information

NPI: 1659780138
Provider Name (Legal Business Name): WAJMA ATAIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2014
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 PARK CREST CT APT A
NOVATO CA
94947-4755
US

IV. Provider business mailing address

PO BOX 1955
NOVATO CA
94948-1955
US

V. Phone/Fax

Practice location:
  • Phone: 415-326-4103
  • Fax:
Mailing address:
  • Phone: 415-326-4103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number102606
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: