Provider Demographics
NPI:1144724626
Name:PIERCY, CARISSA LEIGH (AMFT)
Entity type:Individual
Prefix:MS
First Name:CARISSA
Middle Name:LEIGH
Last Name:PIERCY
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 ALTRURIA DR APT 421
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-0168
Mailing Address - Country:US
Mailing Address - Phone:530-513-8302
Mailing Address - Fax:
Practice Address - Street 1:4820 BUSINESS CENTER DR STE 210
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-1696
Practice Address - Country:US
Practice Address - Phone:707-224-8266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-20
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA127478106H00000X, 101YM0800X
172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No172V00000XOther Service ProvidersCommunity Health Worker