Provider Demographics
NPI:1861826299
Name:PORTILLO GONZALEZ, ADRIANA (MA, MFT, PCC)
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:
Last Name:PORTILLO GONZALEZ
Suffix:
Gender:F
Credentials:MA, MFT, PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21455 BIRCH ST
Mailing Address - Street 2:STE 201
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-2165
Mailing Address - Country:US
Mailing Address - Phone:510-583-0414
Mailing Address - Fax:510-583-0410
Practice Address - Street 1:21455 BIRCH ST
Practice Address - Street 2:STE 201
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-2165
Practice Address - Country:US
Practice Address - Phone:510-583-0414
Practice Address - Fax:510-583-0410
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional