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General NPI Number Information
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NPI Number | 1982137345
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Entity Type | Organization
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Legal Business Name | NORTH COAST FAMILY COUNSELING LLC
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Dates
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Enumeration Date | 04/04/2017
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Last Update Date | 04/04/2017
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Provider Practice Location Address
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Address Line | 508 H ST STE 9
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City | CRESCENT CITY
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State | CA
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Zip | 95531-3723
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Country | US
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Telephone | 707-633-4154
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Fax |
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Provider Business Mailing Address
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Address Line | 900 NORTHCREST DR # 28
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City | CRESCENT CITY
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State | CA
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Zip | 95531-2315
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Country | US
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Telephone | 707-633-4154
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BERNADETTE MARIE JOHNSON
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Credential | MFT
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Telephone | 707-633-4154
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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 | 98897
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License Number State | CA
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