Provider Demographics
NPI:1932234531
Name:MAYORGA, MARILLAC (COUNSELOR)
Entity Type:Individual
Prefix:MRS
First Name:MARILLAC
Middle Name:
Last Name:MAYORGA
Suffix:
Gender:F
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 43RD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-1034
Mailing Address - Country:US
Mailing Address - Phone:415-920-0728
Mailing Address - Fax:415-826-6774
Practice Address - Street 1:820 VALENCIA ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-1737
Practice Address - Country:US
Practice Address - Phone:415-920-0728
Practice Address - Fax:415-826-6774
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)