Provider Demographics
NPI:1982957361
Name:CORDOVA, ABBY JANE-MARIE (MFT)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:JANE-MARIE
Last Name:CORDOVA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8898 NAVAJO ROAD
Mailing Address - Street 2:SUITE C #152
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-3142
Mailing Address - Country:US
Mailing Address - Phone:925-487-0614
Mailing Address - Fax:
Practice Address - Street 1:6472 BOULDER LAKE AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92119-3142
Practice Address - Country:US
Practice Address - Phone:925-487-0614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-22
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 51650106H00000X
CAMFC51650106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist