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General NPI Number Information
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NPI Number | 1972952042
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Entity Type | Individual
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Provider Name | AMANDA VISSERING LPCC, LMHC, PPSC
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Gender |
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Dates
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Enumeration Date | 06/08/2016
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Last Update Date | 12/21/2024
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Provider Practice Location Address
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Address Line | 30 PROFESSIONAL CENTER PKWY
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City | SAN RAFAEL
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State | CA
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Zip | 94903-2757
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Country | US
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Telephone | 206-572-0805
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Fax |
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Provider Business Mailing Address
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Address Line | 8945 GOLF LINKS RD
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City | OAKLAND
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State | CA
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Zip | 94605-4124
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Country | US
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Telephone | 510-654-4004
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 8679
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LH61129627
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 8679
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License Number State | CA
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