Provider Demographics
NPI:1457970584
Name:KONDONIJAKOS, ADI R (PPS, MS)
Entity Type:Individual
Prefix:MS
First Name:ADI
Middle Name:R
Last Name:KONDONIJAKOS
Suffix:
Gender:F
Credentials:PPS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2355 PARISH DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-1525
Mailing Address - Country:US
Mailing Address - Phone:925-588-5725
Mailing Address - Fax:
Practice Address - Street 1:91 MERCEDES LN
Practice Address - Street 2:
Practice Address - City:OAKLEY
Practice Address - State:CA
Practice Address - Zip Code:94561-4617
Practice Address - Country:US
Practice Address - Phone:925-625-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool