Provider Demographics
NPI:1639617699
Name:SONOMA COUNTY CHILD & FAMILY COUNSELING, INC.
Entity Type:Organization
Organization Name:SONOMA COUNTY CHILD & FAMILY COUNSELING, INC.
Other - Org Name:SONOMA COUNTY COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ELIOT
Authorized Official - Last Name:MARGOLIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:707-322-1929
Mailing Address - Street 1:3434 MENDOCINO AVE # A
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-2274
Mailing Address - Country:US
Mailing Address - Phone:707-322-1929
Mailing Address - Fax:707-708-2188
Practice Address - Street 1:3434 MENDOCINO AVE # A
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-2274
Practice Address - Country:US
Practice Address - Phone:707-322-1929
Practice Address - Fax:707-708-2188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT34259106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1689997637Medicaid