Provider Demographics
NPI:1184228918
Name:LAU, ANNA MARIE (CADC-II, WTS)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:LAU
Suffix:
Gender:F
Credentials:CADC-II, WTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 THE ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-1136
Mailing Address - Country:US
Mailing Address - Phone:408-261-7777
Mailing Address - Fax:408-259-2273
Practice Address - Street 1:1046 W TAYLOR ST STE 206
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-1815
Practice Address - Country:US
Practice Address - Phone:408-596-4830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAWTS05141020101Y00000X
CAA051790520101YA0400X
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty