Healthcare Provider Details

I. General information

NPI: 1285588806
Provider Name (Legal Business Name): VASAVI CHARATHRAM FAMILY COUNSELING, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 W FOOTHILL BLVD UNIT D
SAN DIMAS CA
91773-1103
US

IV. Provider business mailing address

PO BOX 1770
LA MESA CA
91944-1770
US

V. Phone/Fax

Practice location:
  • Phone: 626-808-4039
  • Fax:
Mailing address:
  • Phone: 619-464-1165
  • Fax: 619-567-1011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. VASAVI CHARATHRAM
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: LMFT
Phone: 626-803-3948