Provider Demographics
NPI:1447512991
Name:FONSECA, DAVID ANTHONY (LMFT131688)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ANTHONY
Last Name:FONSECA
Suffix:
Gender:M
Credentials:LMFT131688
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 M ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1805
Mailing Address - Country:US
Mailing Address - Phone:559-590-8083
Mailing Address - Fax:
Practice Address - Street 1:1225 M ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1805
Practice Address - Country:US
Practice Address - Phone:559-600-9306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2024-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
CAIMF97667106H00000X
CAAMFT97667106H00000X
CALMFT131688106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health