1710543160 NPI number — MS. ANGELA CLAIRE DOTSON LMFT 112318

Table of content: MS. ANGELA CLAIRE DOTSON LMFT 112318 (NPI 1710543160)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710543160 NPI number — MS. ANGELA CLAIRE DOTSON LMFT 112318

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOTSON
Provider First Name:
ANGELA
Provider Middle Name:
CLAIRE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT 112318
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710543160
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1044 SIR FRANCIS DRAKE BLVD STE 6
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENTFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94904-1454
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-776-5885
Provider Business Mailing Address Fax Number:
510-373-6417

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1044 SIR FRANCIS DRAKE BLVD STE 6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENTFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94904-1454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-776-5885
Provider Business Practice Location Address Fax Number:
510-776-5885
Provider Enumeration Date:
05/10/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  112318 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com