Provider Demographics
NPI:1477388262
Name:CLARVIDA
Entity type:Organization
Organization Name:CLARVIDA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRE-LICENSED THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:LYNNE MARIE
Authorized Official - Last Name:ANDREOLA
Authorized Official - Suffix:
Authorized Official - Credentials:APCC
Authorized Official - Phone:760-896-5713
Mailing Address - Street 1:16940 HIGHWAY 14 STE C-J
Mailing Address - Street 2:
Mailing Address - City:MOJAVE
Mailing Address - State:CA
Mailing Address - Zip Code:93501-1238
Mailing Address - Country:US
Mailing Address - Phone:661-524-5020
Mailing Address - Fax:
Practice Address - Street 1:16940 HIGHWAY 14 STE C-J
Practice Address - Street 2:
Practice Address - City:MOJAVE
Practice Address - State:CA
Practice Address - Zip Code:93501-1238
Practice Address - Country:US
Practice Address - Phone:661-524-5020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PATHWAYS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-03
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty