Provider Demographics
NPI:1659594786
Name:KVIKSTAD, CATHERINE (MFT)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:KVIKSTAD
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21700 REDWOOD RD # B
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-6434
Mailing Address - Country:US
Mailing Address - Phone:510-537-1606
Mailing Address - Fax:510-247-0152
Practice Address - Street 1:21700 REDWOOD RD # B
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-6434
Practice Address - Country:US
Practice Address - Phone:510-537-1606
Practice Address - Fax:510-247-0152
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35214106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist