Provider Demographics
NPI:1619011731
Name:FANAEE, SOHEILA (MFT)
Entity Type:Individual
Prefix:
First Name:SOHEILA
Middle Name:
Last Name:FANAEE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:SOHEILA
Other - Middle Name:
Other - Last Name:FANAEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:3150 HILLTOP MALL ROAD
Mailing Address - Street 2:SUITE #9
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94806
Mailing Address - Country:US
Mailing Address - Phone:510-384-7142
Mailing Address - Fax:510-262-9322
Practice Address - Street 1:3150 HILLTOP MALL RD # 9
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94806-1921
Practice Address - Country:US
Practice Address - Phone:510-384-7142
Practice Address - Fax:510-262-9322
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 52184106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist