Provider Demographics
NPI:1578846069
Name:LAYNE, CAROL
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:LAYNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 HILLEGASS AVE APT C
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2105
Mailing Address - Country:US
Mailing Address - Phone:619-990-1595
Mailing Address - Fax:
Practice Address - Street 1:120 N REDWOOD DR
Practice Address - Street 2:EAST WING
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-1941
Practice Address - Country:US
Practice Address - Phone:415-473-3486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36957106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist