Provider Demographics
NPI:1750035945
Name:AVIVA WOLFSON MARRIAGE AND FAMILY THERAPY INC.
Entity type:Organization
Organization Name:AVIVA WOLFSON MARRIAGE AND FAMILY THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AVIVA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:WOLFSON
Authorized Official - Suffix:
Authorized Official - Credentials:MFT, LPCC
Authorized Official - Phone:818-689-6751
Mailing Address - Street 1:777 N CRAIG AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-4932
Mailing Address - Country:US
Mailing Address - Phone:818-689-6751
Mailing Address - Fax:
Practice Address - Street 1:690 E GREEN ST STE 202
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2197
Practice Address - Country:US
Practice Address - Phone:818-689-6751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)