Basic Information
| Provider Information | |||||||||
| NPI: | 1144724626 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PIERCY | ||||||||
| FirstName: | CARISSA | ||||||||
| MiddleName: | LEIGH | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | AMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 970 ALTRURIA DR APT 421 | ||||||||
| Address2: | |||||||||
| City: | SANTA ROSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954030168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5305138302 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2300 NORTHPOINT PKWY | ||||||||
| Address2: | |||||||||
| City: | SANTA ROSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954075004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7072248266 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2018 | ||||||||
| LastUpdateDate: | 08/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 172V00000X | N | Other Service Providers | Community Health Worker | 101YM0800X | 127478 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.