Healthcare Provider Details

I. General information

NPI: 1508367574
Provider Name (Legal Business Name): DIANA GARCIA DE ALBA LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2018
Last Update Date: 07/26/2021
Certification Date: 07/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 COOK AVE STE 102
PASADENA CA
91107-7323
US

IV. Provider business mailing address

8440 GLORIA AVE
NORTH HILLS CA
91343-6330
US

V. Phone/Fax

Practice location:
  • Phone: 818-810-7763
  • Fax:
Mailing address:
  • Phone: 818-810-7763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMFT93692
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: