Healthcare Provider Details

I. General information

NPI: 1174450084
Provider Name (Legal Business Name): CORINNE HARDISTY, LMFT, MARRIAGE AND FAMILY THERAPY PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 UNION ST
SAN DIEGO CA
92103-6033
US

IV. Provider business mailing address

2929 UNION ST
SAN DIEGO CA
92103-6033
US

V. Phone/Fax

Practice location:
  • Phone: 415-488-3552
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CORINNE HARDISTY
Title or Position: PRESIDENT
Credential: LMFT
Phone: 415-488-3552