Provider Demographics
NPI:1972952042
Name:VISSERING, AMANDA (LPCC, LMHC, PPSC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:VISSERING
Suffix:
Gender:F
Credentials:LPCC, LMHC, PPSC
Other - Prefix:
Other - First Name:AJ
Other - Middle Name:
Other - Last Name:VISSERING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8945 GOLF LINKS RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-4124
Mailing Address - Country:US
Mailing Address - Phone:510-654-4004
Mailing Address - Fax:
Practice Address - Street 1:30 PROFESSIONAL CENTER PKWY
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-2757
Practice Address - Country:US
Practice Address - Phone:206-572-0805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61129627101YM0800X
CA8679101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health