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General NPI Number Information
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NPI Number | 1356753289
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Entity Type | Individual
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Provider Name | MS. LISA-SUN GRESHAM
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Gender | Female
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Dates
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Enumeration Date | 05/27/2014
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Last Update Date | 11/19/2015
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Provider Practice Location Address
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Address Line | 250 BON AIR RD UNIT B
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City | GREENBRAE
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State | CA
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Zip | 94904-1702
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Country | US
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Telephone | 415-473-6835
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Fax |
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Provider Business Mailing Address
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Address Line | 3708 MARKET ST APT A
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City | OAKLAND
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State | CA
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Zip | 94608-3954
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Country | US
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Telephone | 540-519-9309
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State | CA
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