Provider Demographics
NPI:1003959131
Name:DURKIN, CARLA LORRAINE (MFT)
Entity Type:Individual
Prefix:MS
First Name:CARLA
Middle Name:LORRAINE
Last Name:DURKIN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 ALBION ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-1103
Mailing Address - Country:US
Mailing Address - Phone:415-255-6394
Mailing Address - Fax:
Practice Address - Street 1:1304C CASTRO ST # 3
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-3621
Practice Address - Country:US
Practice Address - Phone:415-647-9977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 24407106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist