Provider Demographics
NPI:1538650544
Name:KORDIC MARRIAGE & FAMILY COUNSELING PROF. CORP.
Entity Type:Organization
Organization Name:KORDIC MARRIAGE & FAMILY COUNSELING PROF. CORP.
Other - Org Name:COUNSELING POTENTIAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KORDIC
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:707-298-9801
Mailing Address - Street 1:2386 BRIARWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-7500
Mailing Address - Country:US
Mailing Address - Phone:707-298-9801
Mailing Address - Fax:
Practice Address - Street 1:2386 BRIARWOOD CIR
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-7500
Practice Address - Country:US
Practice Address - Phone:707-298-9801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-24
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center