Provider Demographics
NPI:1407160633
Name:KARVER, MARY WITTE (CADACA, LADC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:WITTE
Last Name:KARVER
Suffix:
Gender:F
Credentials:CADACA, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 MILLICH DRIVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008
Mailing Address - Country:US
Mailing Address - Phone:408-963-6694
Mailing Address - Fax:408-796-7939
Practice Address - Street 1:595 MILLICH DRIVE
Practice Address - Street 2:SUITE 102
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008
Practice Address - Country:US
Practice Address - Phone:408-963-6694
Practice Address - Fax:408-796-7939
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302536101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)