Provider Demographics
NPI:1174323919
Name:GODHA, MALAVIKA (LPCC)
Entity type:Individual
Prefix:
First Name:MALAVIKA
Middle Name:
Last Name:GODHA
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2041 EAST ST APT 994
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-2126
Mailing Address - Country:US
Mailing Address - Phone:510-556-1861
Mailing Address - Fax:
Practice Address - Street 1:39858 POTRERO DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-5604
Practice Address - Country:US
Practice Address - Phone:510-556-1861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC18268101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health