Provider Demographics
NPI:1811887656
Name:VOGT, ALISHA JEAN (LMFT)
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:JEAN
Last Name:VOGT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:ALI
Other - Middle Name:
Other - Last Name:VOGT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:822 D ST STE 4
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-2814
Mailing Address - Country:US
Mailing Address - Phone:510-527-1918
Mailing Address - Fax:
Practice Address - Street 1:822 D ST STE 4
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2814
Practice Address - Country:US
Practice Address - Phone:510-527-1918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47693106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist