Healthcare Provider Details

I. General information

NPI: 1023929536
Provider Name (Legal Business Name): CANDELA CELINA ANASTASI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 NOVA ALBION WAY
SAN RAFAEL CA
94903-3598
US

IV. Provider business mailing address

320 NOVA ALBION WAY
SAN RAFAEL CA
94903-3598
US

V. Phone/Fax

Practice location:
  • Phone: 415-492-3100
  • Fax: 415-492-3105
Mailing address:
  • Phone: 415-492-3100
  • Fax: 415-492-3105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number164402
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number23162
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: