Provider Demographics
NPI:1912483983
Name:BOBO, KATRINA MARY (IMFT 97106, PCCI 354)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:MARY
Last Name:BOBO
Suffix:
Gender:F
Credentials:IMFT 97106, PCCI 354
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:MARY
Other - Last Name:SPRAGGINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:390 40TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-2633
Mailing Address - Country:US
Mailing Address - Phone:510-613-0330
Mailing Address - Fax:510-569-4589
Practice Address - Street 1:390 40TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-2633
Practice Address - Country:US
Practice Address - Phone:510-613-0330
Practice Address - Fax:510-569-4589
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPCCI3543101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health