Healthcare Provider Details

I. General information

NPI: 1750206074
Provider Name (Legal Business Name): MARISOL MORA LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 HARBOR VIEW AVE
OAKLAND CA
94619-2200
US

IV. Provider business mailing address

4200 HARBOR VIEW AVE
OAKLAND CA
94619-2200
US

V. Phone/Fax

Practice location:
  • Phone: 510-898-8352
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10967
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: