Provider Demographics
NPI:1275879835
Name:TINA BOLLENDORF
Entity Type:Organization
Organization Name:TINA BOLLENDORF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLLENDORF
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:510-544-9302
Mailing Address - Street 1:3637 GRAND AVE STE E
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-2029
Mailing Address - Country:US
Mailing Address - Phone:510-544-9302
Mailing Address - Fax:
Practice Address - Street 1:3637 GRAND AVE STE E
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-2029
Practice Address - Country:US
Practice Address - Phone:510-544-9302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-28
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC43033251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management