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General NPI Number Information
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NPI Number | 1396456463
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Entity Type | Organization
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Legal Business Name | DATE WITH INTENTION, INC.
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Dates
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Enumeration Date | 12/09/2022
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Last Update Date | 12/09/2022
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Provider Practice Location Address
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Address Line | 555 SOQUEL AVE STE 260
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City | SANTA CRUZ
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State | CA
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Zip | 95062-2340
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Country | US
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Telephone | 831-252-0900
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Fax | 877-878-2808
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Provider Business Mailing Address
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Address Line | 555 SOQUEL AVE STE 260
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City | SANTA CRUZ
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State | CA
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Zip | 95062-2340
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Country | US
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Telephone | 831-252-0900
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MARISA ABZUG
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Credential | MFT, CPC
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Telephone | 831-252-0900
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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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