Healthcare Provider Details

I. General information

NPI: 1619645322
Provider Name (Legal Business Name): MACIELL GISSELLE COLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 09/03/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 3RD ST STE 1C
SAN FRANCISCO CA
94124-1444
US

IV. Provider business mailing address

3450 3RD ST STE 1C
SAN FRANCISCO CA
94124-1444
US

V. Phone/Fax

Practice location:
  • Phone: 415-437-3990
  • Fax:
Mailing address:
  • Phone: 415-437-3990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: