Provider Demographics
NPI:1003933821
Name:MCCONVILLE, ANN E (MS, MFT)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:E
Last Name:MCCONVILLE
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4660 DOLORES AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-1824
Mailing Address - Country:US
Mailing Address - Phone:510-289-1159
Mailing Address - Fax:510-531-1053
Practice Address - Street 1:4660 DOLORES AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-1824
Practice Address - Country:US
Practice Address - Phone:510-289-1159
Practice Address - Fax:510-531-1053
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35581106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist