Provider Demographics
NPI:1649790791
Name:AVINA, MARIA GUADALUPE (LMFT)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:GUADALUPE
Last Name:AVINA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MRS
Other - First Name:MARIA
Other - Middle Name:GUADALUPE
Other - Last Name:AVINA PATINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:200 VINEYARD VIEW DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-7832
Mailing Address - Country:US
Mailing Address - Phone:707-583-6096
Mailing Address - Fax:
Practice Address - Street 1:2460 W 3RD ST STE 230
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-6411
Practice Address - Country:US
Practice Address - Phone:707-583-6096
Practice Address - Fax:707-900-8192
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF85791106H00000X
CA126511106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist