Individual
AMANDA MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1266 14TH ST, OAKLAND, CA 94607-2205
(510) 273-4700
Mailing address
1266 14TH ST, OAKLAND, CA 94607-2205
(510) 273-4700
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
106H00000X
Marriage & Family Therapist
Primary
138760
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/26/2018
Last updated
06/19/2025
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