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General NPI Number Information
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NPI Number | 1326748393
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Entity Type | Organization
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Legal Business Name | NOIRES SOMATIC: A MARRIAGE AND FAMILY THERAPY CORPORATION
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Dates
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Enumeration Date | 03/07/2023
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 3221 HAMLINE AVE APT 4
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City | OAKLAND
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State | CA
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Zip | 94602-1553
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Country | US
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Telephone | 404-664-5941
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Fax |
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Provider Business Mailing Address
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Address Line | 3221 HAMLINE AVE APT 4
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City | OAKLAND
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State | CA
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Zip | 94602-1553
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Country | US
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Telephone | 404-664-5941
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Fax |
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Authorized Official
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Title or Position | CEP
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Name | SAGE WILLIAMS
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Credential | MFT, SEP
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Telephone | 404-664-5941
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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