Provider Demographics
NPI:1538710322
Name:COLLADA, MIRIAM A (LPCC, LMFT)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:A
Last Name:COLLADA
Suffix:
Gender:
Credentials:LPCC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8885 RIO SAN DIEGO DR STE 365
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1627
Mailing Address - Country:US
Mailing Address - Phone:619-764-3764
Mailing Address - Fax:
Practice Address - Street 1:2525 CAMINO DEL RIO S STE 205
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3719
Practice Address - Country:US
Practice Address - Phone:619-764-3764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-24
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC9769101YP2500X
CA130358106H00000X
CA10633101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist