Healthcare Provider Details

I. General information

NPI: 1730795337
Provider Name (Legal Business Name): FULL CIRCLE PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 09/18/2020
Certification Date: 09/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6741 SEBASTOPOL AVE STE 110
SEBASTOPOL CA
95472-3838
US

IV. Provider business mailing address

6741 SEBASTOPOL AVE STE 110
SEBASTOPOL CA
95472-3838
US

V. Phone/Fax

Practice location:
  • Phone: 510-326-3959
  • Fax:
Mailing address:
  • Phone: 510-326-3959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. CORINNE BARROWS
Title or Position: THERAPIST
Credential: LCSW 96438
Phone: 510-326-3959