Healthcare Provider Details

I. General information

NPI: 1932901485
Provider Name (Legal Business Name): MALCOLM GOVENDER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2025
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 SANTA CLARA AVE STE 205
OAKLAND CA
94610-1323
US

IV. Provider business mailing address

166 SANTA CLARA AVE STE 205
OAKLAND CA
94610-1323
US

V. Phone/Fax

Practice location:
  • Phone: 510-601-1929
  • Fax: 510-601-1947
Mailing address:
  • Phone: 510-601-1929
  • Fax: 510-601-1947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHCA.MC.70111374
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: