Organization
LOST COAST PSYCHOTHERAPY LCSW PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL WALDON LCSW (OWNER)
(707) 489-8814
Entity
Organization
Contact information
Practice address
1178 BROADWAY FL 3, NEW YORK, NY 10001-5666
(929) 262-0794
Mailing address
14 SAN CARLOS AVE, EL CERRITO, CA 94530-4147
(707) 489-8814
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
10/11/2023
Last updated
10/11/2023
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