Individual
KRISTEN E FONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MFT
Contact information
Practice address
1050 NORTHGATE DR, SUITE 12, SAN RAFAEL, CA 94903-2526
(415) 250-0541
Mailing address
1050 NORTHGATE DR, SUITE 12, SAN RAFAEL, CA 94903-2526
(415) 250-0541
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
MFC36228
CA
Other
Enumeration date
03/07/2008
Last updated
07/20/2015
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