Healthcare Provider Details

I. General information

NPI: 1306032156
Provider Name (Legal Business Name): ADRIENNE CLAIRE LOPEZ TILEY M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ADRIENNE CLAIRE LOPEZ

II. Dates (important events)

Enumeration Date: 09/14/2007
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 ROLAND WAY SUITE 100
OAKLAND CA
94621
US

IV. Provider business mailing address

401 ROLAND WAY SUITE 100
OAKLAND CA
94621
US

V. Phone/Fax

Practice location:
  • Phone: 510-746-2800
  • Fax: 510-746-2810
Mailing address:
  • Phone: 510-746-2800
  • Fax: 510-746-2810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: