Most Relevant Information
Provider Data
| NPI Number: | 1003068966 |
| Provider Name: | MARY LIGHTHOLDER |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 10/22/2008 |
| Last Updated: | 08/30/2012 |
Provider Practice Location
500 DAVIS ST
SAN LEANDRO
CA
945772757
Practice Location Phone/Fax
| Phone: | 5106186428 |
| Fax: |
Provider Mailing Location
41225 APRICOT LN
FREMONT
CA
945394501
Provider Mailing Phone/Fax
| Phone: | 5106186428 |
| Fax: |