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General NPI Number Information
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NPI Number | 1033909270
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Entity Type | Individual
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Provider Name | KATHERINE ALISSA FONSECA AMFT/APCC
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Gender | Female
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Dates
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Enumeration Date | 05/10/2025
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Last Update Date | 05/10/2025
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Provider Practice Location Address
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Address Line | 6303 OWENSMOUTH AVE STE 1065A
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City | WOODLAND HILLS
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State | CA
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Zip | 91367-2264
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Country | US
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Telephone | 805-947-0984
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Fax |
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Provider Business Mailing Address
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Address Line | 4934 ACACIA AVE
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City | SAN BERNARDINO
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State | CA
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Zip | 92407-3108
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Country | US
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Telephone | 909-353-8448
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 19027
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 154142
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License Number State | CA
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