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General NPI Number Information
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NPI Number | 1750035945
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Entity Type | Organization
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Legal Business Name | AVIVA WOLFSON MARRIAGE AND FAMILY THERAPY INC.
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Dates
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Enumeration Date | 02/08/2022
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Last Update Date | 02/08/2022
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Provider Practice Location Address
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Address Line | 690 E GREEN ST STE 202
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City | PASADENA
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State | CA
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Zip | 91101-2197
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Country | US
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Telephone | 818-689-6751
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Fax |
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Provider Business Mailing Address
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Address Line | 777 N CRAIG AVE
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City | PASADENA
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State | CA
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Zip | 91104-4932
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Country | US
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Telephone | 818-689-6751
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Fax |
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Authorized Official
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Title or Position | OWNER, PRESIDENT
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Name | AVIVA MICHELLE WOLFSON
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Credential | MFT, LPCC
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Telephone | 818-689-6751
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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