Provider Demographics
NPI:1205431293
Name:WEAVER, EMILY S (MFT)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:S
Last Name:WEAVER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:WEAVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1425 LEIMERT BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-1808
Mailing Address - Country:US
Mailing Address - Phone:510-698-4172
Mailing Address - Fax:
Practice Address - Street 1:1425 LEIMERT BLVD STE 301
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-1808
Practice Address - Country:US
Practice Address - Phone:510-698-4172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39021101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health