Individual
AMY THEODORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
1034 ASTON CIR, SANTA ROSA, CA 95404-6024
(707) 216-1097
Mailing address
1034 ASTON CIR, SANTA ROSA, CA 95404-6024
(707) 815-3400
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
108073
CA
Other
Enumeration date
05/05/2019
Last updated
10/20/2022
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