| Divadiversity | |
|
1171 Homestead Rd Ste 220 Santa Clara CA 95050-5485 | |
| (833) 256-4225 | |
| (408) 904-7444 |
| Full Name | Divadiversity |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 1171 Homestead Rd Ste 220, Santa Clara, California |
| Authorized Official Name and Position | Arlene Ticoulet (CEO) |
| Authorized Official Contact | 8332564225 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Divadiversity 1171 Homestead Rd Ste 220 Santa Clara CA 95050-5485 Ph: (833) 256-4225 | Divadiversity 1171 Homestead Rd Ste 220 Santa Clara CA 95050-5485 Ph: (833) 256-4225 |
| NPI Number | 1548719545 |
|---|---|
| Provider Enumeration Date | 10/02/2016 |
| Last Update Date | 03/31/2020 |
| Certification Date | 03/31/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548719545 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | () | Secondary |
| 103TC0700X | Psychologist - Clinical | () | Secondary |
| 106H00000X | Marriage & Family Therapist | () | Primary |
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