Provider Demographics
NPI:1316974157
Name:COSTA, ALISON B (LMFT)
Entity type:Individual
Prefix:MS
First Name:ALISON
Middle Name:B
Last Name:COSTA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 GARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-4601
Mailing Address - Country:US
Mailing Address - Phone:415-269-0104
Mailing Address - Fax:415-454-8959
Practice Address - Street 1:12 GARDEN AVE
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-4601
Practice Address - Country:US
Practice Address - Phone:415-269-0104
Practice Address - Fax:415-454-8959
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC29052106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist