Healthcare Provider Details

I. General information

NPI: 1578927455
Provider Name (Legal Business Name): CASSANDRA ROMO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CASSIE MARIE ROMO LPCC

II. Dates (important events)

Enumeration Date: 04/07/2016
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 CHALLENGER WAY
SANTA ROSA CA
95407-5418
US

IV. Provider business mailing address

529 FARIA ST
ANTIOCH CA
94509-4829
US

V. Phone/Fax

Practice location:
  • Phone: 707-565-8181
  • Fax:
Mailing address:
  • Phone: 925-303-8216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number15367
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: