Provider Demographics
NPI:1982679718
Name:VON MIDDENDORF, KARINA SUZANNE (MFT)
Entity Type:Individual
Prefix:MS
First Name:KARINA
Middle Name:SUZANNE
Last Name:VON MIDDENDORF
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1083 VINE ST STE 740
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-4830
Mailing Address - Country:US
Mailing Address - Phone:415-408-8801
Mailing Address - Fax:866-849-0672
Practice Address - Street 1:3558 ROUND BARN BLVD SUITE 200
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403
Practice Address - Country:US
Practice Address - Phone:415-408-8801
Practice Address - Fax:866-849-0672
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA38189106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA38189OtherPROFESSIONAL LICENSE