Provider Demographics
NPI:1568779973
Name:VANDIVIER, KRISTI THEONE (MA, MFT)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:THEONE
Last Name:VANDIVIER
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:
Other - Last Name:THEONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, MFT
Mailing Address - Street 1:415 CAMBRIDGE AVE
Mailing Address - Street 2:SUITE # 8
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-1600
Mailing Address - Country:US
Mailing Address - Phone:650-473-9798
Mailing Address - Fax:650-424-0142
Practice Address - Street 1:415 CAMBRIDGE AVE
Practice Address - Street 2:SUITE # 8
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1600
Practice Address - Country:US
Practice Address - Phone:650-473-9798
Practice Address - Fax:650-424-0142
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT #48882106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFT # 48882OtherBOARD OF BEHAVIORAL SCIENCES