Provider Demographics
NPI:1083211858
Name:DEKKER, DARICE ELAINE (LMFT)
Entity Type:Individual
Prefix:
First Name:DARICE
Middle Name:ELAINE
Last Name:DEKKER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17321 PARK AVE APT A
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-8508
Mailing Address - Country:US
Mailing Address - Phone:707-548-9813
Mailing Address - Fax:
Practice Address - Street 1:17321 PARK AVE APT A
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-8508
Practice Address - Country:US
Practice Address - Phone:707-548-9813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA122276106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist