Healthcare Provider Details

I. General information

NPI: 1083307367
Provider Name (Legal Business Name): LETA HUANG MA, APCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2023
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

862 FOLSOM ST
SAN FRANCISCO CA
94107-1123
US

IV. Provider business mailing address

700 FREDERICK ST STE 103
SANTA CRUZ CA
95062-2239
US

V. Phone/Fax

Practice location:
  • Phone: 831-996-1222
  • Fax:
Mailing address:
  • Phone: 831-996-1222
  • Fax: 831-417-0443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC23110
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: