Provider Demographics
NPI:1780156513
Name:LUBIN-AMAYA, XOCHIQUETZAL CARMELA (AMFT, APCC)
Entity type:Individual
Prefix:MS
First Name:XOCHIQUETZAL
Middle Name:CARMELA
Last Name:LUBIN-AMAYA
Suffix:
Gender:F
Credentials:AMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 N. GRAVENSTEIN HWY
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472
Mailing Address - Country:US
Mailing Address - Phone:707-634-9050
Mailing Address - Fax:707-823-3410
Practice Address - Street 1:1800 N. GRAVENSTEIN HWY
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472
Practice Address - Country:US
Practice Address - Phone:707-634-9050
Practice Address - Fax:707-823-3410
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5876101Y00000X, 101YM0800X
CA110438101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health