# CHANGE BY CONIAH FAMILY COUNSELING, A PROFESSIONAL CORPORATION

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1467931022
- **Authorized official:** MRS. CAROL LETRESSE WALLACE LMFT (CEO)
- **Authorized official phone:** (916) 531-5647

## Contact information

- **Practice address:** 2376 MARITIME DR STE 200, ELK GROVE, CA 95758-3640
- **Practice address phone:** (916) 531-5647
- **Practice address fax:** (916) 405-3470
- **Mailing address:** 2376 MARITIME DR STE 200, ELK GROVE, CA 95758-3640
- **Mailing address phone:** (916) 531-5647
- **Mailing address fax:** (916) 531-5647

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 106H00000X | Marriage & Family Therapist | LMFT48746 | CA | Yes |

## Other

- **Enumeration date:** 08/14/2018
- **Last updated:** 08/14/2018