Provider Demographics
NPI:1851462410
Name:ST. CLARE, ADRIANE (MFT)
Entity Type:Individual
Prefix:DR
First Name:ADRIANE
Middle Name:
Last Name:ST. CLARE
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 1:1100 MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:FORTUNA
Mailing Address - State:CA
Mailing Address - Zip Code:95540-2148
Mailing Address - Country:US
Mailing Address - Phone:707-725-9375
Mailing Address - Fax:707-725-9375
Practice Address - Street 1:1100 MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:FORTUNA
Practice Address - State:CA
Practice Address - Zip Code:95540-2148
Practice Address - Country:US
Practice Address - Phone:707-725-9375
Practice Address - Fax:707-725-9375
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 22498106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist