Healthcare Provider Details

I. General information

NPI: 1871824706
Provider Name (Legal Business Name): CARLA SOMMERS MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2010
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 PENDLETON WAY
OAKLAND CA
94621-2102
US

IV. Provider business mailing address

PO BOX 92
ALAMEDA CA
94501-0392
US

V. Phone/Fax

Practice location:
  • Phone: 510-635-6626
  • Fax:
Mailing address:
  • Phone: 510-635-6622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT53837
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: