Healthcare Provider Details

I. General information

NPI: 1609156421
Provider Name (Legal Business Name): ROYAL COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2011
Last Update Date: 08/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 BRONTE ST
SAN FRANCISCO CA
94110
US

IV. Provider business mailing address

162 BRONTE ST
SAN FRANCISCO CA
94110-6239
US

V. Phone/Fax

Practice location:
  • Phone: 415-730-0292
  • Fax:
Mailing address:
  • Phone: 415-730-0292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number66784
License Number StateCA

VIII. Authorized Official

Name: MS. MAGGIE B. DE VERA
Title or Position: SUPERVISOR
Credential: MFT
Phone: 415-643-7117