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General NPI Number Information
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NPI Number | 1619776945
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Entity Type | Organization
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Legal Business Name | TLC FAMILY AND CHILDREN SERVICES
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Dates
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Enumeration Date | 03/10/2025
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 821 MENDOCINO AVE
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City | SANTA ROSA
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State | CA
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Zip | 95401-4805
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Country | US
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Telephone | 707-867-8082
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Fax |
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Provider Business Mailing Address
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Address Line | 1800 HWY 116 N
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City | SEBASTOPOL
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State | CA
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Zip | 95472-2607
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Country | US
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Telephone | 707-823-7300
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SUSAN FETTE
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Credential |
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Telephone | 707-823-7300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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