Provider Demographics
NPI:1972794287
Name:COPITHORNE, MARK (MFTI, MA)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:COPITHORNE
Suffix:
Gender:M
Credentials:MFTI, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EARTH CIRCLES COUNSELING
Mailing Address - Street 2:560 OAKLAND AVENUE
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-0000
Mailing Address - Country:US
Mailing Address - Phone:510-601-1929
Mailing Address - Fax:
Practice Address - Street 1:560 OAKLAND AVE
Practice Address - Street 2:EARTH CIRCLES COUNSELING
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5471
Practice Address - Country:US
Practice Address - Phone:510-601-1929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50436106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist