Provider Demographics
NPI:1326748393
Name:NOIRES SOMATIC: A MARRIAGE AND FAMILY THERAPY CORPORATION
Entity Type:Organization
Organization Name:NOIRES SOMATIC: A MARRIAGE AND FAMILY THERAPY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEP
Authorized Official - Prefix:
Authorized Official - First Name:SAGE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MFT, SEP
Authorized Official - Phone:404-664-5941
Mailing Address - Street 1:3221 HAMLINE AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-1553
Mailing Address - Country:US
Mailing Address - Phone:404-664-5941
Mailing Address - Fax:
Practice Address - Street 1:3221 HAMLINE AVE APT 4
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-1553
Practice Address - Country:US
Practice Address - Phone:404-664-5941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty