Provider Demographics
NPI:1508155367
Name:KREKLER, LISA MARIE (LCSW, DSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:KREKLER
Suffix:
Gender:F
Credentials:LCSW, DSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 POSTAL WAY UNIT 2996
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92085-7121
Mailing Address - Country:US
Mailing Address - Phone:760-237-8112
Mailing Address - Fax:760-330-2108
Practice Address - Street 1:3017 TELEGRAPH AVE
Practice Address - Street 2:STE 210
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705
Practice Address - Country:US
Practice Address - Phone:760-237-8112
Practice Address - Fax:760-330-2108
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-01
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 257341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical