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General NPI Number Information
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NPI Number | 1386920189
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Entity Type | Individual
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Provider Name | LARISSA ROSE WOLFORD M.A., LMFT
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Gender | Female
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Dates
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Enumeration Date | 10/25/2011
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Last Update Date | 01/09/2016
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Provider Practice Location Address
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Address Line | 1683 NOVATO BLVD STE 8
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City | NOVATO
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State | CA
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Zip | 94947-3284
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Country | US
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Telephone | 415-609-4077
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Fax |
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Provider Business Mailing Address
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Address Line | 1683 NOVATO BLVD STE 8
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City | NOVATO
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State | CA
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Zip | 94947-3284
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Country | US
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Telephone | 415-609-4077
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 47710
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1065
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number | 140082874
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License Number State | CA
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