Provider Demographics
NPI:1124899984
Name:BODHI HEALING MARRIAGE & FAMILY THERAPY
Entity type:Organization
Organization Name:BODHI HEALING MARRIAGE & FAMILY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT
Authorized Official - Prefix:
Authorized Official - First Name:VANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DJAVID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-334-7171
Mailing Address - Street 1:1151 DOVE ST STE 244
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2806
Mailing Address - Country:US
Mailing Address - Phone:949-334-7171
Mailing Address - Fax:
Practice Address - Street 1:1151 DOVE ST STE 244
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2806
Practice Address - Country:US
Practice Address - Phone:949-334-7171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-10
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty