Healthcare Provider Details

I. General information

NPI: 1205245263
Provider Name (Legal Business Name): ERICA VILLARREAL-KONE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2014
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 4TH ST
SANTA ROSA CA
95404-4057
US

IV. Provider business mailing address

1275 4TH ST
SANTA ROSA CA
95404-4057
US

V. Phone/Fax

Practice location:
  • Phone: 415-729-5616
  • Fax:
Mailing address:
  • Phone: 415-729-5616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number123574
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: