Basic Information
| Provider Information | |||||||||
| NPI: | 1700364379 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOLVITES | ||||||||
| FirstName: | LISA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1217A S B ST | ||||||||
| Address2: | |||||||||
| City: | SAN MATEO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 944022429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503150260 | ||||||||
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| Practice Location | |||||||||
| Address1: | 826 MAHLER RD | ||||||||
| Address2: | |||||||||
| City: | BURLINGAME | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940101604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6506895597 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2018 | ||||||||
| LastUpdateDate: | 08/05/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | R1303370418 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.