Healthcare Provider Details

I. General information

NPI: 1942372974
Provider Name (Legal Business Name): LAURA FAIRCHILD JOINER M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 05/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3239 SACRAMENTO ST
SAN FRANCISCO CA
94115-2047
US

IV. Provider business mailing address

3239 SACRAMENTO ST
SAN FRANCISCO CA
94115-2047
US

V. Phone/Fax

Practice location:
  • Phone: 415-830-4611
  • Fax:
Mailing address:
  • Phone: 415-830-4611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 49071
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC 812
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: