Healthcare Provider Details

I. General information

NPI: 1700368099
Provider Name (Legal Business Name): TARINA FRANCES ANN KOLLARS AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2018
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 CAMINO DEL RIO S STE 201
SAN DIEGO CA
92108-3505
US

IV. Provider business mailing address

4443 30TH ST
SAN DIEGO CA
92116-4288
US

V. Phone/Fax

Practice location:
  • Phone: 619-381-7748
  • Fax:
Mailing address:
  • Phone: 619-597-7335
  • 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:
Title or Position:
Credential:
Phone: