Provider Demographics
NPI:1801081385
Name:CREPSAC, JOELLE L (LMFT, ATR, APCC)
Entity type:Individual
Prefix:MS
First Name:JOELLE
Middle Name:L
Last Name:CREPSAC
Suffix:
Gender:F
Credentials:LMFT, ATR, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3044 75TH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-2906
Mailing Address - Country:US
Mailing Address - Phone:650-520-5833
Mailing Address - Fax:510-777-1187
Practice Address - Street 1:16378 E 14TH ST STE 101
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-5121
Practice Address - Country:US
Practice Address - Phone:510-459-8046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA138513106H00000X
101YA0400X, 390200000X, 390200000X, 101Y00000X
CA10142101YP2500X
CA24-189221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program