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General NPI Number Information
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NPI Number | 1275879835
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Entity Type | Organization
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Legal Business Name | TINA BOLLENDORF
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Dates
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Enumeration Date | 12/28/2012
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Last Update Date | 12/28/2012
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Provider Practice Location Address
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Address Line | 3637 GRAND AVE STE E
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City | OAKLAND
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State | CA
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Zip | 94610-2029
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Country | US
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Telephone | 510-544-9302
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Fax |
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Provider Business Mailing Address
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Address Line | 3637 GRAND AVE STE E
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City | OAKLAND
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State | CA
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Zip | 94610-2029
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Country | US
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Telephone | 510-544-9302
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | TINA BOLLENDORF
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Credential | MA
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Telephone | 510-544-9302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | MFC43033
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License Number State | CA
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