Provider Demographics
NPI:1003683798
Name:DAHLSTROM, ROSEMARIE (LMFT)
Entity Type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:
Last Name:DAHLSTROM
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:ROSEMARIE
Other - Middle Name:
Other - Last Name:SMEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 QUAIL ST STE 155
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2765
Mailing Address - Country:US
Mailing Address - Phone:949-777-6694
Mailing Address - Fax:
Practice Address - Street 1:1000 QUAIL ST STE 155
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2765
Practice Address - Country:US
Practice Address - Phone:949-777-6694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA143006106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist