Provider Demographics
NPI:1033123849
Name:MEDINA, ADOLFO JORGE (LMFT)
Entity Type:Individual
Prefix:MR
First Name:ADOLFO
Middle Name:JORGE
Last Name:MEDINA
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:AL
Other - Middle Name:
Other - Last Name:MEDINA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, LMFT
Mailing Address - Street 1:5978 GREENWOOD CMN
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-4798
Mailing Address - Country:US
Mailing Address - Phone:925-373-6654
Mailing Address - Fax:925-373-6654
Practice Address - Street 1:5978 GREENWOOD CMN
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4798
Practice Address - Country:US
Practice Address - Phone:925-518-9168
Practice Address - Fax:925-373-6654
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2011-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC35047106H00000X, 101YM0800X, 101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool