Provider Demographics
NPI:1992416143
Name:MAYORGA, FERNANDA MICHELLE (LMFT)
Entity type:Individual
Prefix:
First Name:FERNANDA
Middle Name:MICHELLE
Last Name:MAYORGA
Suffix:
Gender:
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2717 CARDIFF CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94806-2636
Mailing Address - Country:US
Mailing Address - Phone:415-260-6539
Mailing Address - Fax:
Practice Address - Street 1:2717 CARDIFF CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94806-2636
Practice Address - Country:US
Practice Address - Phone:415-260-6539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-08
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT149157106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist