Basic Information
| Provider Information | |||||||||
| NPI: | 1679783633 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LONDON | ||||||||
| FirstName: | CATHY | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6333 TELEGRAPH AVE | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946091359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108620775 | ||||||||
| FaxNumber: | 5103976458 | ||||||||
| Practice Location | |||||||||
| Address1: | 3541 JAMISON WAY # 130 | ||||||||
| Address2: | |||||||||
| City: | CASTRO VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945464301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108620775 | ||||||||
| FaxNumber: | 5102526533 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2007 | ||||||||
| LastUpdateDate: | 07/17/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | LMFT45170 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.