Amanda Vissering, LPCC, LMHC, PPSC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

8679 Issued in CA

Practice address

30 Professional Center Pkwy
San Rafael, CA 94903-2757

Phone

(206) 572-0805

NPI assigned

Jun 8, 2016

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other names 1

• Aj Vissering Other name

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Seneca Family of Agencies

  • Community/Behavioral Health Agency
  • Concord, CA
  • NPI 1073643680
  NPD (past)
• Seneca Family of Agencies

  • Community/Behavioral Health Agency
  • San Rafael, CA
  • NPI 1942472147
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1465344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734739200000",
    "number": "1972952042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8945 GOLF LINKS RD",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946054124",
            "telephone_number": "510-654-4004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 PROFESSIONAL CENTER PKWY",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949032757",
            "telephone_number": "206-572-0805"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "445 Bellevue Ave Ste 6C",
            "address_purpose": "LOCATION",
            "city": "Oakland",
            "state": "CA",
            "postal_code": "946104923",
            "country_code": "US",
            "telephone_number": "206-317-4417",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VISSERING",
        "first_name": "AMANDA",
        "credential": "LPCC, LMHC, PPSC",
        "sole_proprietor": "YES",
        "sex": "U",
        "enumeration_date": "2016-06-08",
        "last_updated": "2024-12-21",
        "certification_date": "2024-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CA",
            "license": "8679",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "LH61129627",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "8679",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AJ",
            "last_name": "VISSERING",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Visionary Healthcare
• Jazmine-Ciara Bayangos Visperas
• Anne Marie Vitale, PHD
• Alisha Jean Vogt, LMFT
• Sheba Vohra, M.D.
• Nadia Smith Volk
• Rachel Fitzmaurice Von Doepp, IBCLC

• Professional Counselor in San Rafael, CA
• Providers in San Rafael, CA by specialty
• Professional Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.