| Change By Coniah Family Counseling, A Professional Corporation | |
|
2376 Maritime Dr Ste 200 Elk Grove CA 95758-3640 | |
| (916) 531-5647 | |
| (916) 405-3470 |
| Full Name | Change By Coniah Family Counseling, A Professional Corporation |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 2376 Maritime Dr Ste 200, Elk Grove, California |
| Authorized Official Name and Position | Carol Letresse Wallace (CEO) |
| Authorized Official Contact | 9165315647 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Change By Coniah Family Counseling, A Professional Corporation 2376 Maritime Dr Ste 200 Elk Grove CA 95758-3640 Ph: (916) 531-5647 | Change By Coniah Family Counseling, A Professional Corporation 2376 Maritime Dr Ste 200 Elk Grove CA 95758-3640 Ph: (916) 531-5647 |
| NPI Number | 1467931022 |
|---|---|
| Provider Enumeration Date | 08/14/2018 |
| Last Update Date | 08/14/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467931022 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | LMFT48746 (California) | Primary |
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