Healthcare Provider Details

I. General information

NPI: 1326188590
Provider Name (Legal Business Name): KALIFA COULIBALY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 HARRISON ST
SAN FRANCISCO CA
94107-1235
US

IV. Provider business mailing address

760 HARRISON ST
SAN FRANCISCO CA
94107-1235
US

V. Phone/Fax

Practice location:
  • Phone: 415-836-1784
  • Fax: 415-357-0159
Mailing address:
  • Phone: 415-836-1784
  • Fax: 415-357-0159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: