Provider Demographics
NPI:1811520687
Name:METAXAS, VAN DEAN (LMFT)
Entity type:Individual
Prefix:MR
First Name:VAN
Middle Name:DEAN
Last Name:METAXAS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:MR
Other - First Name:VAN
Other - Middle Name:ARAVIND
Other - Last Name:METAXAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1304 SOLANO AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-1826
Mailing Address - Country:US
Mailing Address - Phone:415-929-8502
Mailing Address - Fax:
Practice Address - Street 1:1304 SOLANO AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-1826
Practice Address - Country:US
Practice Address - Phone:415-929-8502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT32323106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist