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MS. CAROL DIANE BLOOMQUIST MA MFT

>> Marriage & Family Therapist >> Behavioral Health & Social Service Providers

Registrant NPI Number: 1104199835

Individual Registrant:
MS. CAROL DIANE BLOOMQUIST MA MFT
Gender: F
Sole Proprietor

Location and contact information for practice:
3428 SILVERADO TRL N  SAINT HELENA, CA 94574-9662 US
Tel: 707-963-1419  Fax: 707-963-0841

Contact information for business:
PO BOX 403  SAINT HELENA, CA 94574-0403 US
Tel: 707-963-1419  Fax: 707-963-0841

Registration Information:
NPI: 1104199835
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y106H00000XBehavioral Health & Social Service Providers
Marriage & Family Therapist
CAMFC 24307

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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