Provider Demographics
NPI:1336565001
Name:LIVINGSTON, ANNIKA JOY (BA)
Entity type:Individual
Prefix:MISS
First Name:ANNIKA
Middle Name:JOY
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 DWIGHT WAY
Mailing Address - Street 2:214
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-1969
Mailing Address - Country:US
Mailing Address - Phone:760-622-9697
Mailing Address - Fax:
Practice Address - Street 1:3800 COOLIDGE AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-3311
Practice Address - Country:US
Practice Address - Phone:510-418-7241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-05
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARI-L1403041330101YA0400X
390200000X
CA84887101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program