Provider Demographics
NPI:1427599703
Name:COUNSELING TO INSPIRE, INC.
Entity Type:Organization
Organization Name:COUNSELING TO INSPIRE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:CICCHETTO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, LPCC
Authorized Official - Phone:707-514-5812
Mailing Address - Street 1:1300 OLIVER RD STE 193
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-3431
Mailing Address - Country:US
Mailing Address - Phone:707-514-5812
Mailing Address - Fax:707-673-5549
Practice Address - Street 1:1300 OLIVER RD STE 193
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-3431
Practice Address - Country:US
Practice Address - Phone:707-514-5812
Practice Address - Fax:707-673-5549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-20
Last Update Date:2019-07-13
Deactivation Date:2019-07-03
Deactivation Code:
Reactivation Date:2019-07-13
Provider Licenses
StateLicense IDTaxonomies
CAMFC 43693106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty